Predictors Of Limb Loss Among Patients With Vascular Injury To The Extremity
Dimitri J. Mabarak, B.S.1, Faraz Behzadi, B.S.1, Maelee Yang, M.D.1, Amy Wozniak, MS2, Bernadette Aulivola, M.D.1.
1Loyola University Medical Center, Maywood, IL, USA, 2Loyola University Stritch School of Medicine, Maywood, IL, USA.
OBJECTIVES: Currently, 2 million individuals in the U.S. are living with limb amputations, 54% as a result of vascular disease, and 45% related to trauma. While the risk of amputation from an isolated vascular injury is low, the risk seems to increase significantly when it is concomitant with other injuries (i.e. orthopedic) to the same limb. Limited studies have demonstrated this circumstance, and even fewer have observed additional factors that may predict limb loss. This study aims to not only confirm the greater risk of limb loss from concomitant orthopedic and soft tissue injuries, but also additional factors (i.e. comorbidities and demographics) that could potentially predict amputation in patients who present with a vascular limb injury.
METHODS: A retrospective review of patients with vascular injury at a single medical institution between 2007-2018 were evaluated. Demographic and medical data of 250 patients was abstracted and analyzed.
RESULTS: Using simple logistic regression models, it was found that factors including: concomitant orthopedic injury, soft tissue injury, nerve injury, or fasciotomy increased the risk of a necessary amputation. Furthermore, increased age and BMI were associated with an increased odds of limb loss. In multivariable analyses, orthopedic injury [OR (CI): 13.78 (4.49, 42.25), p=<0.001] and related return to the OR [OR (CI): 4.05 (1.57, 10.42), p=<0.001] remained significant after adjusting for other risk factors.
CONCLUSIONS: These data suggest that patients who present with concomitant orthopedic injury, multiple same-limb operations, and even high BMI or age may require a different course of treatment. With this knowledge of significant risk factors, further development of a vascular limb injury protocol may be created to enhance limb salvage.
| Risk Factor | Odds Ratio of Limb Loss (CI) | P-value |
| Orthopedic injury | 18.00 (6.161,52.587) | <.0001 |
| Soft Tissue Injury | 2.609 (1.312,5.187) | 0.0062 |
| Fasciotomy | 3.593 (1.763,7.325) | 0.0004 |
| Related return to the OR | 6.171 (2.703,14.088) | <.0001 |
| Nerve Injury | 2.182 (1.1, 4.328) | 0.0256 |
| Age | 1.024 (1.003,1.045) | 0.0257 |
| BMI | 1.079 (1.007,1.156) | 0.0309 |
| Hypertension | 2.00 (0.887,4.511) | 0.0949 |
| Diabetes | 2.158 (0.404,11.532) | 0.3684 |
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