Renal Function as a Predictor of Early Transmetatarsal Amputation Failure

Area of Science:

• Nephrology
• Vascular Surgery
• Podiatry

Background:

• Chronic kidney disease (CKD) is linked to neuropathy, peripheral vascular disease, and poor wound healing, complicating foot disease management.
• Patients with CKD face higher risks of adverse outcomes following lower extremity amputations.

Purpose of the Study:

• To investigate renal dysfunction as a predictor of reamputation after transmetatarsal amputation (TMA).
• To assess the impact of varying levels of kidney function on TMA outcomes.

Main Methods:

• Retrospective analysis of 2018 patients who underwent TMA, identified from the American College of Surgeons National Surgical Quality Improvement Program database.
• Statistical analysis to determine the association between renal dysfunction and TMA failure, major amputation, and 30-day mortality.

Main Results:

• Reamputation after TMA occurred in 4.4% of patients.
• End-stage renal disease (ESRD) was associated with doubled odds of TMA failure (OR=2.00), increased odds of major amputation (OR=2.28), and higher 30-day mortality (OR=2.82).
• Elevated white blood cell count and deep surgical site infection were also linked to TMA failure.

Conclusions:

• Severe renal dysfunction, particularly ESRD, is a significant risk factor for short-term TMA failure and perioperative mortality.
• No increased risk of TMA failure was observed with worsening renal function prior to ESRD.
• A multidisciplinary approach is recommended for CKD patients to prevent foot pathologies requiring amputation.