Factors Associated with Urgent Amputation Status and Its Impact on Mortality

Area of Science:

• Vascular Surgery
• Health Disparities
• Outcomes Research

Background:

• Thirty-day mortality rates are significantly higher for urgent major lower extremity amputations compared to elective procedures.
• Identifying factors associated with urgent amputations is critical for understanding and improving perioperative and long-term outcomes.

Purpose of the Study:

• To identify factors associated with urgent lower extremity amputations.
• To examine the impact of urgent amputation on perioperative complications and long-term mortality.

Main Methods:

• Analysis of 12,874 patients undergoing major lower limb amputation from 2013-2020 in the Vascular Quality Initiative.
• Urgent amputation defined as occurring within 72 hours of admission.
• Comparison of sociodemographic characteristics, comorbidities, and outcomes using univariable and multivariable logistic regression, with long-term survival analyzed via Kaplan-Meier.

Main Results:

• Urgent amputations (37.7%) were more common in Non-White patients, Medicaid/self-pay individuals, and those with higher American Society of Anesthesiologists (ASA) class 4-5.
• Reasons for urgent amputation included uncontrolled infection and acute limb ischemia.
• Urgent amputations were associated with higher postoperative complications (34.7% vs. 16.6%), inpatient mortality (8.9% vs. 5.4%), and increased long-term mortality (OR 1.24).

Conclusions:

• Urgent amputations are linked to significant disparities in care access, affecting non-White, uninsured, and less revascularized populations.
• Urgency in amputation is a predictor of increased postoperative complications and long-term mortality.
• Targeted efforts to reduce these disparities are essential for improving patient outcomes after major lower extremity amputation.