Highlights
- •Postoperative multidisciplinary teams increase odds of reaching ambulation.
- •Postamputation ambulation significantly improved odds of survival.
- •Postamputation ambulation may reduce postoperative mortality.
- •On average, more patients achieve ambulation yearly.
Background
We hypothesize among patients undergoing lower extremity amputation, access to pre-,
and post operative rehabilitation services; as well as improved medical care, have
led to higher rates of postoperative ambulation, and improved survival.
Methods
Retrospective single center review of all major lower extremity amputations performed
at the Greater Los Angeles Veterans Affairs Healthcare System from 2000–2020 stratified
into multiyear cohorts. We abstracted demographics, operative indication, comorbidities,
preoperative medical management, perioperative complications, discharge location,
and pre and postoperative ambulatory status. Odds of ambulation after amputation were
analyzed using multivariate logistic regression. Survival was analyzed using multivariate
logistic regression and Kaplan-Meier survival analysis. Multivariate logistic predictors
were selected based on prior literature and clinical experience.
Results
We identified 654 operations in our study, noting fewer amputations performed in the
latest 3 cohort years as compared to the initial cohort (2000–2004). Patients undergoing
below-knee amputations (BKA) had 2.7 times (P < 0.05) greater odds of postoperative ambulation and 86% (P < 0.05) increased odds of survival compared to above-knee amputations (AKA). The
odds of ambulation increased by 8.8% (P < 0.05) for each consecutive study year. Ambulation post-amputation conferred 13.2
times (P < 0.05) greater odds of survival. The odds of survival in “emergent” operations decreased
by 48% (P < 0.05) compared to an “elective” operation. For each additional comorbidity, the
odds of survival decreased by 18% (P < 0.05). Patients with any perioperative complication had a 48% (P < 0.05) lower odds of survival. Kaplan-Meier survival estimates demonstrated significant
survival difference between patients by amputation level and postoperative ambulatory
status (P < 0.05).
Conclusions
Ambulatory status following distal amputation has improved over time and is significantly
associated with increased survival post-amputation. Patients undergoing a BKA or discharged
home were most likely to ambulate postoperatively. Amputation level, preoperative
comorbidities, and perioperative complications remain strong predictors of survival.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Annals of Vascular SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Reducing nontraumatic lower-extremity amputations by 20% by 2030: time to get to our feet: a policy statement from the American heart association.Circulation. 2021; 143 (Epub ahead of print. PMID: 33761757): e875-e891
- Predicting functional status following amputation after lower extremity bypass.Ann Vasc Surg. 2012; 26: 67-78
- DPM what role does function play in deciding on limb salvage versus amputation in patients with diabetes?.Plast Reconstr Surg. 2016; 138: 188S-195S
- Outcomes of major lower extremity amputations in dysvascular patients: room for improvement.Am J Surg. 2020; 220: 1506-1510
- Preoperative clinical factors predict postoperative functional outcomes after major lower limb amputation: an analysis of 553 consecutive patients.J Vasc Surg. 2005; 42: 227-235
- Predictors of operative mortality following major lower extremity amputations using the National Surgical Quality Improvement Program public use data.J Vasc Surg. 2013; 58: 1276-1282
- Multidisciplinary care improves amputation-free survival in patients with chronic critical limb ischemia.J Vasc Surg. 2015; 61: 162-169
- Does the presence of a specialized rehabilitation unit in a Veterans Affairs facility impact referral for rehabilitative care after a lower-extremity amputation?.Arch Phys Med Rehabil. 2007; 88: 1249-1255
- Association of statin dose with amputation and survival in patients with peripheral artery disease.Circulation. 2018; 137: 1435-1446
- Efficacy and safety of antiplatelet therapies in symptomatic peripheral artery disease: a systematic review and network meta-analysis.Curr Vasc Pharmacol. 2021; 19: 542-555
Article Info
Publication History
Published online: July 07, 2022
Accepted:
June 7,
2022
Received:
March 3,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Declarations of interest: none.
Identification
Copyright
Published by Elsevier Inc.
