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Present-day analysis of early failure after forefoot amputation
Benjamin R Zambetti1, Zachary E Stiles1, Prateek K Gupta2
1Department of Surgery, Division of Vascular Surgery, University of Tennessee Health Science Center, Memphis, TN.
Surgery
|August 2, 2020
Summary
Forefoot transmetatarsal amputation failure requiring more proximal amputation occurred in 4.2% of patients. Preoperative sepsis or septic shock independently predicted this early reamputation, increasing morbidity.
Area of Science:
- Podiatric surgery
- Vascular surgery
- Surgical outcomes research
Background:
- Transmetatarsal amputation (TMA) is a common limb salvage procedure.
- However, TMAs have a high failure rate, often necessitating more proximal amputations.
- Few studies have investigated the incidence and risk factors for major amputation following TMA.
Purpose of the Study:
- To determine the incidence of major amputation (transtibial or transfemoral) after TMA.
- To identify risk factors associated with early reamputation after TMA.
- To examine outcomes for patients requiring reamputation post-TMA.
Main Methods:
- Utilized the 2012-2016 American College of Surgeons National Quality Improvement Program database.
- Identified patients who underwent complete transmetatarsal amputation.
- Compared patients needing early (≤30 days) proximal amputation with those who did not, using multivariable logistic regression to find risk factors.
Main Results:
- 1,582 TMAs were analyzed; 4.2% required early reamputation.
- Early reamputation correlated with longer hospital stays, increased wound complications, pneumonia, stroke, and overall complications.
- Preoperative systemic inflammatory response, sepsis, or septic shock were independent predictors (OR 2.1) of early reamputation.
Conclusions:
- Early reamputation after TMA significantly increases patient morbidity.
- Patients with preoperative sepsis are at higher risk for TMA failure.
- Careful consideration of amputation level is crucial for patients with preoperative sepsis.
