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Outcomes After Major Amputation In Octogenarians
Kyle Bui, BS, Anish Patel, BA, Andrea Alonso, MD, Khuaten Maaneb de Macedo, MD, Elina Farber, Alik Farber, MD, MBA, Jeffrey Kalish, MD, Jeffrey J. Siracuse, MD, MBA.
Boston University, Boston, MA, USA.
OBJECTIVES:
Major amputation can be morbid and significantly life changing. Older patients, in particular, may be susceptible to poor outcomes. Our goal was to assess short and long-term outcomes of major amputation in octogenarians.
METHODS:
A retrospective single-center chart review was performed on patients older than 80 years who underwent a major amputation, defined as an amputation above the ankle, at a safety-net hospital between the years 2014-2023. Patient demographics, operative characteristics, post-operative outcomes, and 30-day and 1-year outcomes were collected and analyzed.
RESULTS:
Of 57 octogenarian patients who underwent a major amputation, mean age was 84.8 years, 57.9% were male, and 64.9% were of Black race. Past medical history included hypertension (94.7%), diabetes mellitus (68.4%), coronary artery disease (56.1%), prior lower extremity (LE) bypass (19.3%), endovascular revascularization (31.6%), and contralateral leg amputations (12.3%). Preoperatively, 56.1% of patients lived at home. The main indication for amputation was chronic limb threatening ischemia (CLTI) (96.5%) and acute limb ischemia (3.5%). CLTI presentation included gangrene/ulcers (87.7%) of which 28.0% presented with systemic sepsis, rest pain (8.8%), and acute limb ischemia (3.5%). Immediately prior to amputation, 7% of patients underwent diagnostic angiogram, 5.3% endovascular revascularization, 3.5% LE bypass, and 1.8% embolectomy. There were 68.4% above-the-knee, 22.8% below-the-knee, and 8.8% guillotine amputations. Post-operative intensive care was required in 33.3% patients with a mean hospital length of stay (LOS) of 13.5 days. Upon discharge, 56.1% of patients were discharged to a skilled nursing facility, 17.5% acute rehab facility, and 12.3% home with assistance. Thirty-day emergency department presentation was 15.8%, and hospital readmission was 14%. Most patients (84.2%) were non-ambulatory at 1-year. The in-hospital mortality was 8.8%, 30-day mortality was 14%, and 1-year mortality was 36.8%.
CONCLUSIONS:
Major amputations in octogenarians are morbid with high intensive care utilization, prolonged LOS, and need for long-term care facilities. Over one third of patients are not alive at one year with the majority being non-ambulatory. Early revascularization, control of infection and improved goals of care discussions are opportunities for improvement in this patient population.
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