Amputations in Sepsis Patients: A Population-Based Cohort Study of Rates and Risk Factors

A rare and serious adverse outcome of sepsis is surgical amputation. Limited research has examined the prevalence and risk factors associated with amputations among sepsis patients.

To (i) assess the rate of sepsis-related amputations in hospitals and (ii) identify associated risk factors.

A retrospective cohort study of sepsis patients admitted to any hospital in New South Wales, Australia, from 1 January 2015, to 31 January 2021. The primary outcome was the rate of amputations in sepsis patients. The secondary outcome was amputation risk factors, identified using multivariable logistic regression.

There were 158 842 sepsis patients hospitalised during the study period. The amputation rate was 1.11% (1637/148061) in non-maternal adult patients, 0% (0/3656) in maternal sepsis patients, and < 0.15% (< 10/7125) in paediatric patients. In adult patients with septic shock (n = 20 354), 283 (1.39%) had an amputation. After adjustment for sex, age group, socioeconomic status, geographical remoteness, diabetes and peripheral arterial disease (PAD), factors associated with a higher odds of amputation in adult patients (n = 148 061) were being male (adjusted Odds Ratio [aOR] 2.16, 95% CI: 1.93-2.43; p < 0.001), having diabetes (aOR 9.06, 95% CI: 8.01-10.23; p < 0.001) or having PAD (aOR 19.29, 95% CI: 17.01-21.88; p < 0.001). Compared to patients aged ≥ 85 years, those 16 to 59 years (aOR 3.65, 95% CI: 3.00-4.44; p < 0.001) and 60 to 84 years (aOR 2.19, 95% CI: 1.83-2.63; p < 0.001) also had higher odds of amputation.

This large population study provides much-needed evidence on the burden and risk factors of amputations in sepsis patients.