Outcomes After Major Amputation in Octogenarians

BackgroundMajor lower extremity amputations, defined as above-ankle amputations, are morbid and significantly life-changing. Older patients may be more susceptible to poor outcomes. Our goal was to assess the short- and long-term outcomes of major amputations in octogenarians.MethodsA retrospective single-center chart review was performed on all octogenarian patients who underwent a major amputation at a safety-net hospital between 2014-2023. Demographics, operative characteristics, postoperative outcomes, and 30-day and 1-year outcomes were collected and analyzed. Multivariable binary logistic regression evaluated factors associated with 1-year mortality. Fisher's exact test evaluated univariate categorical comparisons because of small cell frequencies.Results56 octogenarian patients underwent a major amputation: 96.4% underwent an amputation for chronic limb-threatening ischemia while 3.6% of patients had acute limb ischemia. Above-knee and below-knee amputations accounted for 73.2 and 26.8% of procedures, respectively; 10.6% were guillotine amputations. Intensive care unit (ICU) admission was required in 26.3% of cases, and total mean hospital length of stay (LOS) was 13.7 days. Postoperatively, 55.4% were discharged to a skilled nursing facility, 17.9% patients to an acute rehab facility, and 12.5% to home with assistance. Thirty-day emergency department use rate was 14.3%, and hospital readmission rate was 12.5%. Most patients (83.9%) were non-ambulatory at 1-year. In-hospital mortality was 8.9%, 30-day mortality was 14.3%, and 1-year mortality was 35.7%. Univariate analyses demonstrated no statistically significant differences among evaluated variables. Multivariable analysis of 1-year mortality was also not statistically significant.ConclusionMajor amputations in octogenarians are highly morbid with high ICU utilization and prolonged LOS with frequent discharge to acute care facilities. About one-third of patients are not alive at 1-year. These findings suggest the need to identify opportunities for improvement in this high-risk patient population undergoing amputations, such as early revascularization, aggressive rehabilitation in concert with geriatrician collaboration, medical optimization, and improved goals-of-care discussions.