Decisions in Crisis: Amputation Timing and Short-Term Outcomes in Severe Blunt Lower Limb Trauma

Limb amputation is a challenging decision, and delayed procedures may be associated with higher complication rates. This study compares outcomes between early and late amputation in patients with isolated blunt severe lower limb injuries.

We retrospectively reviewed the Trauma Quality Improvement Program (2017-2021), including all ages with isolated severe blunt lower limb injury (Abbreviated Injury Scale ≥ 3) who underwent amputation. Patients were stratified into early (≤48 h) and late (>48 h) amputation groups. The primary outcome was mortality, while secondary outcomes included in-hospital complications, hospital and intensive care unit (ICU) length of stay, and discharge disposition. Propensity score matching was performed to compare outcomes between groups.

Of 4439 patients included, 1959 cases (44.1%) had early amputation (mean procedure time of 1.25 ± 0.43 d), and 2480 cases (55.9%) had late amputations (mean procedure time of 10.34 ± 9.05 d). After matching (1733 per group), mortality did not differ between groups (P = 0.06). Patients in the early amputation group, compared to the late amputation group, had lower rates of acute kidney injury (2.3% versus 4.6%), osteomyelitis (0.7% versus 1.4%), unplanned intubation (1.2% versus 2.4%), unplanned ICU admission (2.8% versus 5.3%), unplanned return to the operation room (2.5% versus 7.9%), and higher rates of home discharge (30.9% versus 27.5%) (P < 0.05). The hospital and ICU length of stay were significantly lower in the early amputation group compared to the late amputation group (P < 0.001).

Early amputation in serious blunt lower limb injuries was associated with fewer observed complications, shorter hospital and ICU stays, and a higher rate of home discharge compared to late amputation.