Undernutrition is associated with higher rate of reamputation or survival, lower mobility and lower quality of life following dysvascular major lower limb amputation: a longitudinal observational study

Objective To investigate the association between undernutrition and survival, reamputation-free survival, quality of life (Qol), wound healing, mobility, and work status post-dysvascular major lower limb amputation (LLA). Design Longitudinal observational multicenter study. Setting At multiple settings, including hospitals, rehabilitation/care facilities, and at home. Participants Adults who have undergone dysvascular major LLA (n=81) in 2023, without severe malabsorption disease. Interventions NA. Main outcome measures Participants' nutritional status (PG-SGA) was assessed at <12 days, 5 weeks, 6 months, and 9 months post-LLA. (Reamputation-free) survival and QoL (WHOQoL-BREF) were assessed at 5 weeks, 6 months, and 9 months, wound healing at 5 weeks, mobility (K-level) at 6 and 9 months, and work status at 9 months post-LLA. Results Eighty-one participants were included (mean age 69.7±10.5 years; 73% male; 73% transtibial LLA). Participants who died (n=14) or required reamputation (n=4) were undernourished at <12 days post-LLA. Undernutrition was significantly associated with lower reamputation-free survival (χ 2 =3.976, p=0.046) and lower physical and psychological QoL (B=-7.6, p=0.003; B=-9.9, p<0.001), but not with survival (χ 2 =2.637, p=0.101) and impaired wound healing (OR=1.88, p=0.272). Undernutrition was significantly associated with lower mobility (K-level 0/1 vs 2/3/4; OR=0.20, p=0.035) at 6 months post-LLA, but not at 9 months (OR=0.33, p=0.303). Lower PG-SGA score was significantly associated with longer survival and reamputation-free survival, and better QoL, higher mobility, and higher rates of employment/volunteering. Conclusions These findings highlight the relevance of undernutrition in the dysvascular major LLA population, and the critical need for nutritional interventions to prevent or limit undernutrition, with the potential to improve outcomes such as reamputation-free survival, QoL, and mobility.