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Analysis of Early Lower Extremity Re-amputation.

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  • 1Department of Surgery, Division of Vascular Surgery, University of Tennessee Health Science Center, Memphis, TN.

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Summary
This summary is machine-generated.

Early re-amputation after lower extremity amputation is uncommon but linked to worse outcomes. Risk factors include older age, smoking, and preoperative septic shock.

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Area of Science:

  • Vascular Surgery
  • Reconstructive Surgery
  • Health Outcomes Research

Background:

  • Limited data exists on outcomes and risk factors for early re-amputation to a higher level after major lower extremity amputation.
  • This study aims to address this gap by defining outcomes and identifying risk factors for re-amputation.

Purpose of the Study:

  • To determine the incidence of early re-amputation following major lower extremity amputation.
  • To identify patient demographics and peri-operative factors associated with early re-amputation.
  • To analyze the impact of early re-amputation on patient outcomes, including length of stay, readmission, and complications.

Main Methods:

  • A retrospective analysis of patients undergoing primary major lower extremity amputation was conducted using the 2012-2016 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.
  • Demographic, peri-operative, and outcome data were collected and compared between patients with and without early re-amputation.
  • Multivariable logistic regression was employed to identify independent risk factors associated with early re-amputation.

Main Results:

  • Over a four-year period, 8306 below-knee and 6367 above-knee amputations were identified. Early (30-day) re-amputation occurred in 262 patients (1.8%).
  • Re-amputation was significantly associated with increased length of stay (12.9 vs. 7.3 days), higher readmission rates (64.9% vs. 13.6%), and more overall complications (69.5% vs. 39.3%).
  • Multivariable analysis revealed advanced age, smoking, dialysis dependence, preoperative septic shock, and bleeding disorders as significant risk factors for early re-amputation.

Conclusions:

  • Thirty-day re-amputation rates following major lower extremity amputation are low.
  • However, early re-amputation is associated with substantial morbidity, prolonged hospitalization, and increased readmissions.
  • Identifying and mitigating risk factors for early re-amputation is crucial for improving patient outcomes.