Risk Factors For Wound Complications After Lower Extremity Amputation: Analysis Of Vasqip
Wayne Tse, MD, Kedar Lavingia, MD, Michael F. Amendola, MD.
VA Medical Center/VCU Health System, Richmond, VA, USA.
OBJECTIVES: Lower extremity amputations (LEA) for chronic limb ischemia are plagued by wound complications due to inherent patient factors that necessitated the amputation. We have analyzed the Veteran Affairs Surgical Quality Improvement Program (VASQIP) in effort to identify risk factors for wound complications after LEA.METHODS: After obtaining IRB approval, VASQIP data was obtained for fiscal year 1999 to 2018. CPT codes for above and below knee amputations (AKA, BKA) were used to identify patients. Pre-operative comorbidities and peri-operative variables were extracted from this database. Wound complications were defined as wound disruption/dehiscence or surgical site infection (SSI). Data was analyzed with univariate analysis and forward stepwise logistic regression in SPSS (v25, IBM) to determine the risk factors for wound complications.RESULTS: There was a total of 50,083 unique patients identified. 98.8% of patients were male with an average age of 66 ± 10 years. There were 28,768 BKAs and 21,315 AKAs. The rate of post-operative wound complication was 6.4% (n=3,201). When risk adjusted, wound complications were higher in patients with COPD (OR 1.22, 95% CI 1.11-1.31, p<0.001 ), chronic steroid use (OR 1.26, 95% CI 1.02-1.55, p=0.032), non-independent functional status (OR 1.16, 1.03-1.30, p<0.001), smoking within the last year (OR 1.25, 95% CI 1.14-1.37, p<0.001), longer operative times (OR 1.13, 95% CI 1.09-1.19, p<0.001), BKA (OR 1.38, 95% CI 1.26-1.50, p <0.001), and general surgeons performing the amputation (OR 1.20 , 95% CI 1.10-1.31, p<0.001).CONCLUSION: Wound complications after major LEA continues to be commonplace. Risk factors for wound complications include COPD, chronic steroid use, non-independent functional status, smoking within the last year, BKA, and general surgeons performing the surgery. These findings highlight the need to consider the patient’s preoperative comorbidities to determine their ability heal the amputation prior to surgery.
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