Difficult to predict early failure after major lower-extremity amputations.

INTRODUCTION: The successful outcome of a major amputation depends on several factors, including stump wound healing. The purpose of this study was to examine the criteria upon which the index amputation was based and to identify factors associated with early amputation failure after major non-traumatic lower-extremity amputation.

METHODS: We studied a consecutive one-year series of 36 men and 34 women with a median (25-75% quartiles) age of 72 (63-83) years who were treated in an acute orthopaedic ward; 44 below-knee and 26 above-knee amputees of whom 47 had an American Society of Anesthesiologists rating above two. Patient characteristics and other factors potentially influencing early amputation failure within 30 days were evaluated.

RESULTS: Eleven patients died (16%) and 11 (16%) had a re-amputation at a higher level, whereas four (6%) had a major revision at the same level within 30 days. Amputations were performed by a house officer (n = 29), a specialist registrar (n = 27) or a consultant (n = 14). A total of 28 surgeons performed the included operations. Neither a preoperative skin perfusion test (only measured for 25 patients), nor any of the many other factors evaluated predicted early amputation failure. Patients with one or more failures stayed in the ward for a median of 45 (33-57) days versus 20 (14-25) days for those without failures.

CONCLUSIONS: The rate of short-term amputation failures was high, and no clear explanation for this was established. A pre-amputation algorithm to support the right choice of amputation level is needed.

FUNDING: none.

TRIAL REGISTRATION: This trial was registered with the Danish Data Protection Agency (R. no. 01975 HVH-2012-053).