Traumatic lower extremity amputation as a risk factor for venous thromboembolism

Area of Science:

• Trauma surgery
• Vascular surgery
• Critical care medicine

Background:

• Lower extremity (LE) amputation in civilian trauma casualties is evaluated as a potential risk factor for venous thromboembolism (VTE).
• Understanding VTE risk associated with LE amputation is crucial for patient management and outcomes.

Purpose of the Study:

• To determine if lower extremity amputation following severe trauma is associated with an increased risk of developing venous thromboembolism (VTE).

Main Methods:

• Analysis of a nationwide trauma database (ACS-TQIP, 2013-2020) including patients with severe LE injuries (AIS ≥3).
• Comparison of VTE rates (pulmonary embolism [PE] and deep vein thrombosis [DVT]) between patients undergoing LE amputation versus limb salvage.
• Propensity score matching was employed to control for confounding variables and selection bias.

Main Results:

• A total of 145,667 patients with severe LE injuries were analyzed; 3443 underwent LE amputation.
• Patients with LE amputation had significantly higher rates of PE (4.2% vs. 2.5%) and DVT (6.5% vs. 3.4%) compared to limb salvage patients.
• Sensitivity analysis on isolated major LE trauma confirmed higher incidences of PE and DVT in amputated patients.

Conclusions:

• Traumatic lower extremity amputation is independently associated with a significantly elevated risk of VTE events.
• This includes increased rates of both pulmonary embolism and deep vein thrombosis.
• The findings underscore the importance of VTE prophylaxis in patients undergoing LE amputation after trauma.