Re-amputations and mortality after below-knee, through-knee and above-knee amputations

Area of Science:

• Surgery
• Orthopedics
• Vascular Surgery

Background:

• Surgical strategies for non-traumatic major lower-extremity amputations were revised in January 2013, with a cessation of through-knee amputations (TKA).
• This study evaluates the impact of this change on re-amputation and mortality rates.

Purpose of the Study:

• To investigate re-amputation rates within 90 days following major lower-extremity amputations before and after the cessation of TKA.
• To compare all-cause mortality rates within 90 days between the two study periods.

Main Methods:

• Retrospective analysis of non-traumatic major lower-extremity amputations in two cohorts: 2009-2012 (Cohort A) and 2014-2015 (Cohort B).
• Data collected included amputation type (below-knee amputation [BKA], TKA, above-knee amputation [AKA]), re-amputation rates, and all-cause mortality within 90 days.

Main Results:

• Cohort A (pre-cessation): 180 amputations; overall re-amputation rate 21.6%, mortality 35.2%.
• Cohort B (post-cessation): 116 amputations; overall re-amputation rate 5.2%, mortality 32.8%.
• Re-amputation rates decreased significantly after TKA cessation (22% to 5%), while mortality remained comparable.

Conclusions:

• Cessation of through-knee amputations led to a significant reduction in early re-amputation rates for major lower-extremity amputations.
• The change in surgical strategy did not impact 90-day all-cause mortality.