Patient outcomes following lower leg major amputations for peripheral arterial disease: A series review.

INTRODUCTION: Despite improvements in revascularization, major amputation remains a significant part of the case-mix in vascular surgical units. These patients tend to be elderly with complex pathology, resulting in poor outcomes and longer lengths of stay (LOS).

AIM: This series review provides a description of the patient complexities and outcomes in an Australian cohort undergoing major lower limb amputation for peripheral arterial disease.

METHOD: Medical records coded for major amputation between July 2012 and June 2013 in an Australian government funded, tertiary hospital were retrospectively reviewed and descriptively analyzed.

FINDINGS: Twenty-five patients had 29 major amputations including four conversions from below to above knee. Seventeen had multiple vascular procedures before amputation. The average LOS exceeded the national target, and there was substantial morbidity and 30-day mortality.

CONCLUSION: Major amputation continues to present challenges because of patient frailty and the high rate of complications. These issues need to be considered in a robust care planning framework that includes consideration of cognitive decline and other markers of frailty. Opportunities to optimize the physical condition of these patients and to reduce delays in proceeding to surgery require further investigation.