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An Analysis of Risk Factors for Complication Following Upper Extremity Amputation.

Dhruv Mendiratta1, Connor Fletcher1, Isabel Herzog1

  • 1Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.

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|March 13, 2026
PubMed
Summary
This summary is machine-generated.

Preoperative risk factors like hyponatremia, hypoalbuminemia, cardiac disease, and diabetes increase the risk of complications following upper extremity amputations (UEAs). Proximal amputations, such as shoulder disarticulation, are also associated with higher complication rates.

Keywords:
AmputationHandOrthopedicsUpper Extremity

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Area of Science:

  • Surgical Outcomes Research
  • Amputation Surgery
  • Patient Risk Stratification

Background:

  • Upper extremity amputations (UEAs) represent a significant portion of all amputations, yet risk factors are less understood than for lower extremity amputations (LEAs).
  • Existing literature primarily focuses on LEA risk factors like diabetes, necessitating research into UEA-specific predictors.
  • This study aims to identify preoperative risk factors associated with complications after UEA.

Purpose of the Study:

  • To investigate preoperative risk factors for adverse outcomes in patients undergoing upper extremity amputations.
  • To elucidate associations between patient comorbidities and amputation level with postoperative complications.
  • To provide data for improved patient counseling and risk management in UEA cases.

Main Methods:

  • Analysis of the American College of Surgeons National Surgical Quality Improvement Program Database (2006-2018).
  • Inclusion of patients undergoing various levels of UEA (shoulder disarticulation, transhumeral, transradial, transcarpal).
  • Statistical analysis using Chi-squared and multivariate binary regression to identify independent risk factors for complications, prolonged length of stay, reoperation, surgical site infection, and death.

Main Results:

  • Hyponatremia, hypoalbuminemia, history of cardiac disease, and shoulder disarticulation (SD) were identified as independent risk factors for major systemic complications.
  • SD amputation was linked to increased risk of major systemic complications, shock/septic shock, and prolonged length of stay (LOS).
  • Diabetes was an independent risk factor for prolonged LOS, unplanned reoperation, and surgical site infection (SSI).

Conclusions:

  • Patients undergoing UEA with hyponatremia, hypoalbuminemia, cardiovascular disease, or diabetes face an elevated risk of 30-day complications.
  • Proximal amputations, specifically shoulder disarticulation, are associated with a higher likelihood of severe complications and extended hospital stays.
  • The findings highlight the importance of addressing preoperative patient conditions to mitigate risks following upper extremity amputations.