Weight Loss Following Major Lower Extremity Amputation is Associated with Increased Rate of Readmission and Need for Amputation Revision
Luke M. Stewart, BS, Dean J. Yamaguchi, MD.
East Carolina University Brody School of Medicine, Greenville, NC, USA.
OBJECTIVES: Readmission after lower extremity major amputation has been associated with increased mortality and cost. Wound complication has been identified as a common risk factor for readmission. The purpose of this retrospective chart review was to identify risk factors that lead to readmission and operative revision following major lower extremity amputation.
METHODS: A retrospective chart review of all patients who underwent major lower extremity amputation at Vidant Medical Center in Greenville, NC from 2013 to 2015 was completed. Variables examined included post-operative weight, weight at readmission/follow-up within six months, comorbidities, and albumin levels during the post-operative period and at follow-up/readmission. Weight change in patients requiring revision, patients readmitted for reasons other than revision within six months, and patients who were not readmitted within six months was compared using two sample t-test. Change in albumin levels from post-operative period to follow-up/readmission was also analyzed using two-sample t-test.
RESULTS: One-hundred seventeen patients underwent below-knee amputation (BKA) and two-hundred fifty patients underwent above-knee amputation (AKA) during this time period. In patients that had an AKA and required revision, the weight change at readmission for revision was -5.156kg (N=29) compared to +1.129kg (N= 56, p=.0000295) in patients who were not readmitted within 6 months (Figure 1A). Patients readmitted for reasons other than revision of their initial amputation had a weight change of -3.117kg (N=93). Patients who required revision of AKA had a change in albumin of -0.165g/dL(N=17) at readmission compared to +0.255g/dL (N=87, p=.00000102) in patients who did not require revision (Figure 1C). In the BKA subset, weight change in patients requiring revision was -3.651kg (N=42) compared to +0.126kg (N=50, p=0.0132) in patients not readmitted within 6 months (Figure 1B). Weight change in patients readmitted for reasons other than revision within 6 months was -3.678kg (N=13). Change in albumin in patients that required revision was -0.239g/dL (N=28) compared to +0.190g/dL (N=30 p=0.014) in patients who did not undergo revision (Figure 1D).
CONCLUSIONS: Patients who demonstrate weight loss in the post-operative period after initial major amputation are at increased risk of readmission and revision of initial amputation, perhaps as a consequence of nutritional deficiency.
Back to 2017 Karmody Posters
