An Analysis of Risk Factors for Complication Following Upper Extremity Amputation

Upper extremity amputations (UEAs) comprise anywhere from 14% to 50% of amputations. Risk factors for lower extremity amputations (LEA), such as diabetes, have been established in the literature. The authors attempt to illuminate similar associations with UEA, which have been studied to a lesser degree. In this study, the authors explore preoperative risk factors that may predispose patients to complications after UEA.

The American College of Surgeons National Surgical Quality Improvement Program Database was queried from 2006 to 2018 for patients undergoing various levels of UEA using current procedural terminology codes. Demographic and comorbidity data were collected, including level of amputation; levels included shoulder disarticulation (SD), transhumeral/elbow disarticulation, transradial/wrist disarticulation, and transcarpal. Outcomes included major systemic complications, prolonged length of stay (LOS), unplanned reoperation, surgical site infection (SSI), and death. Chi-squared and multivariate binary regression analysis were used to determine odds ratios.

Overall, 3907 patients undergoing UEA were identified. Upon multivariate binary regression analysis, hyponatremia, hypoalbuminemia, history of cardiac disease, and SD were independent risk factors for major systemic complications. SD amputation was an independent risk factor for major systemic complications, shock/septic shock, and prolonged LOS. History of cardiac disease was an independent risk factor for major systemic complications, prolonged LOS, and death. Diabetes was an independent risk factor for prolonged LOS, unplanned reoperation, and SSI.

The study found that in patients undergoing UEA, there was an increased risk of 30-day complications in those with hyponatremia, hypoalbuminemia, cardiovascular disease, diabetes, and proximal amputations.