Mortality Risk of Upper Extremity Amputation in Patients With Peripheral Artery Disease

Area of Science:

• Vascular Surgery
• Public Health
• Epidemiology

Background:

• Peripheral artery disease (PAD) significantly impacts patient mortality, particularly when complicated by the need for upper extremity amputation (UEA).
• Understanding the specific mortality risks associated with UEA in PAD patients is crucial for clinical decision-making and patient management.

Purpose of the Study:

• To investigate and clarify the mortality risk associated with upper extremity amputation (UEA) in patients diagnosed with peripheral artery disease (PAD).

Main Methods:

• Retrospective analysis of the TriNetX database using ICD-10 and CPT codes to identify PAD patients with and without UEA.
• Propensity score matching (1:1 ratio) was employed to balance cohorts based on key demographic and comorbidity factors.
• Kaplan-Meier survival analysis and hazard ratios were utilized to assess mortality at 1, 5, and 10 years post-amputation.

Main Results:

• The study identified over 1.8 million PAD patients, with 1,862 undergoing UEA.
• Patients with PAD who underwent UEA exhibited substantially higher mortality rates at 1, 5, and 10 years compared to those who did not (e.g., 24.1% vs. 14.1% at 1 year).
• UEA was consistently associated with an increased mortality risk across all time points, with hazard ratios ranging from 1.705 to 1.767.

Conclusions:

• Upper extremity amputation in PAD patients is linked to a significantly elevated risk of mortality.
• The findings highlight the critical need for early detection of PAD, comprehensive patient education, and proactive preventive measures to mitigate disease progression and amputation necessity.
• Long-term survival remains poor for PAD patients undergoing amputation, irrespective of the amputation level (digit or forearm).