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In-Hospital Morbidity and Mortality of Traumatic Lower-Extremity Amputations.

Samuel F Thompson, Kristopher B McCall, Dil V Patel

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    |August 4, 2020
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    Higher-level traumatic lower-extremity amputations (through-knee/above-knee) lead to worse outcomes than below-knee amputations, including more complications and longer hospital stays.

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    Area of Science:

    • Orthopedic Surgery
    • Trauma Surgery
    • Rehabilitation Medicine

    Background:

    • Traumatic lower-extremity amputations frequently lead to complications and require further surgical interventions.
    • Understanding in-hospital outcomes is crucial for managing patients with traumatic amputations.

    Purpose of the Study:

    • To compare the in-hospital morbidity and mortality between below-knee (BK) and through-knee/above-knee (TK/AK) traumatic lower-extremity amputations.
    • To identify complication rates and resource utilization for different amputation levels.

    Main Methods:

    • Retrospective review of 168 adult patients with traumatic lower-extremity amputations from 2005 to 2015.
    • Data collected included amputation level, complication rates, ICU admission, length of stay, operating room trips, and Injury Severity Score (ISS).

    Main Results:

    • Patients with TK/AK amputations had significantly higher ICU admission rates (76% vs 35%), longer hospital stays (22.0 vs 15.5 days), more OR trips (6.5 vs 5.0), and higher ISS (17.0 vs 11.5) compared to BK amputations.
    • Overall complication rate was 64%, with TK/AK amputations experiencing higher rates of wound infection, pulmonary embolism, rhabdomyolysis, compartment syndrome, and death.

    Conclusions:

    • Traumatic TK/AK amputations are associated with a greater injury burden and poorer in-hospital outcomes than BK amputations.
    • These findings highlight the need for tailored management strategies for higher-level traumatic amputations to mitigate complications and optimize patient recovery.