Key result
Derived risk score linking age, COPD, and hemodialysis predicts ~220% higher 30-day mortality in high-risk patients.
Why the study?
Mortality after major lower extremity amputation for peripheral arterial obstructive disease remains high and unchanged over the years, and risk stratification is not adequately sensitive.
Cohort (n=286)
No
Odds Ratio: 3.2 (95% CI 1.63–6.32)
Absolute Event Rate: 28.7% vs 10.8%
p-value: p=<0.001
May aid preoperative risk stratification after major amputation; leaves open prospective validation before clinical use.
To analyze outcomes following major lower extremity amputations (mLEAs) for peripheral arterial obstructive disease, gangrene, infected non-healing wound and to create a risk prediction scoring system for 30-day mortality. In this single-center, retrospective, observational cohort study. All patients treated with above-the-knee amputation (AKA) or below-the-knee amputation (BKA) between January 1st, 2010 and June 30th, 2018 were identified. The primary outcome of interest was early (≤ 30 days) mortality. Secondary outcomes were postoperative complications and freedom from amputation stump revision/failure. We identified 310 (77.7%) mLEAs performed on 286 patients. There were 188 (65.7%) men and 98 (34.3%) women with a median age of 79 years (IQR, 69-83 years). We performed 257 (82.9%) AKA and 53 (17.1%) BKA. There were 49 (15.8%) early deaths, which did not differ among the age quartiles of this cohort (15.4% vs. 14.3% vs. 15.4% vs. 19.5%, P = 0.826). Binary logistic regression analysis identified age > 80 years (OR 2.24, 95% CI 1.17-4.31; P = 0.015), chronic obstructive pulmonary disease (OR 2.12, 95% CI 1.11-4.06; P = 0.023), and hemodialysis (OR 2.52, 95% CI 1.15-5.52; P = 0.021) to be associated with early mortality. The final score (range 0-10) identified two subgroups with different mortality at 30 days: lower-risk (score < 4, 10.8%), and higher-risk (score ≥ 4: 28.7%; OR 3.2, 95% CI 1.63-6.32; P < 0.001). In our experience, mLEAs still have a 14% mortality rate over the years. Our lower-risk group (score < 4) is characterized by a lower rate of perioperative death and longer survival.
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Franchin et al. (2021) conducted a cohort in Peripheral arterial obstructive disease (n=286). Higher predictive risk score (≥ 4 points) vs. Lower predictive risk score (< 4 points) was evaluated on 30-day mortality (OR 3.2, 95% CI 1.63-6.32, p=<0.001). A derived risk score combining age > 80 years, COPD, and hemodialysis strongly predicted 30-day mortality, with high-risk patients (score ≥ 4) experiencing a 28.7% mortality rate versus 10.8% in low-risk patients (OR 3.2).
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