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OBJECTIVES: Among patients with non-salvageable lower extremity disease, patients with above knee amputation traditionally have worse operative mortality and functional outcome compared to patients with below knee amputation. We hypothesized that despite recent advances in medical care, patients with many medical comorbid conditions would have worse long term outcome after amputation. Therefore, we examined the long-term outcome of patients in a high risk population undergoing major lower extremity amputation.
METHODS: Between July 2005 and June 2010, all patients who underwent a major lower extremity amputation at the VA Connecticut Healthcare System were included. A retrospective review of charts was conducted and preoperative, operative and post-operative data was collected. JMP ® 9.0.0 software was used for data analysis.
RESULTS: 54 patients underwent a total of 60 major lower extremity amputations. All patients were male; mean age was 65.9 years. 60% (n=36) underwent BKA and 40% (n=24) underwent AKA. Patients with BKA or AKA had comparable preoperative demographics and comorbidities. The 30-day mortality was 7% (n=4) with no difference in level (BKA, 8%; AKA, 4%; p=0.53). Post-operative MI and stroke were 1.7% (n=1) and 5% (n=3), respectively. The mean follow-up time was 39.7 +/- 29.8 months, and during follow-up (90 months) 38% developed a new MI, stroke, CHF or ESRD, which were comparable between BKA and AKA groups. The 5-year survival was 54% in the whole group, and was independent of level of amputation (p=0.24) or urgency of the procedure (p=0.51). Survival was significantly decreased by the presence of underlying chronic kidney disease (p= 0.04) but not by other comorbidities (history of MI p=0.79, metabolic syndrome p= 0.64, diabetes mellitus p= 0.56).
CONCLUSIONS: Long term survival is independent of the level of lower extremity amputation. However, patients with major lower extremity amputation and underlying CKD constitute a sub-group at risk of higher mortality.