Major Lower Extremity Amputation: Outcome of a Modern Series
Abstract
HYPOTHESIS: Major lower extremity amputation results in significant morbidity and mortality. DESIGN: Retrospective database query and medical record review for January 1, 1990, to December 31, 2001. Mean follow-up was 33.6 months. SETTING: Academic tertiary care center. PATIENTS: Nine hundred fifty-nine consecutive major lower extremity amputations in 788 patients, including 704 below-knee amputations (BKAs) (73.4%) and 255 above-knee amputations (AKAs) (26.6%). MAIN OUTCOME MEASURES: Patient survival, cardiac morbidity, infectious complications, and subsequent operation. RESULTS: Overall 30-day mortality was 8.6%, worse for AKA (16.5%) than BKA (5.7%) patients (P<.001). Thirty-day mortality for guillotine amputation for sepsis control was 14.3% compared with 7.8% for closed amputation (P =.03). Complications included cardiac (10.2%), wound infection (5.5%), and pneumonia (4.5%). Twelve AKA (4.7%) and 129 BKA (18.4%) limbs required subsequent operation. Only 66 BKAs (9.4%) required conversion to AKA (average, 77.1 days postoperatively). Overall survival was 69.7% and 34.7% at 1 and 5 years, respectively. Survival was significantly worse for AKAs (50.6% and 22.5%) than BKAs (74.5% and 37.8%) (P<.001). Survival in patients with diabetes mellitus (DM) was 69.4% and 30.9% vs 70.8% and 51.0% in patients without DM at 1 and 5 years, respectively (P =.002). Survival in end-stage renal disease patients was 51.9% and 14.4% vs 75.4% and 42.2% in patients without renal failure at 1 and 5 years, respectively (P<.001). CONCLUSIONS: Major amputation continues to result in significant morbidity and mortality. Survivors with BKA require revision or conversion to AKA infrequently. Long-term survival is dismal for patients with DM and end-stage renal disease and those undergoing AKA.
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The 5-year mortality rate for patients with diabetic foot ulcers or ischemic ulcers is much higher than that of prostate or breast cancer.
“Although not an immediately obvious concept, the 5-year mortality rate for patients suffering from DFU or ischemic ulcers is much higher than that of prostate or breast cancer (11-13).”
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- Authors
- Aulivola, B.
- Affiliations
- Beth Israel Deaconess Medical Center (US)
- Corresponding author
- Aulivola, Bernadette
- ORCID
- Aulivola, Bernadette
- Venue
- Archives of Surgery
- Publisher
- American Medical Association (AMA)
- Published
- 2004-04-01
- Volume
- 139
- Issue
- 4
- Pages
- 395
- ISSN
- 0004-0010 (ISSN-L)
- OpenAlex
- W2026985226
- Cited by
- 526
- References
- 20
- Citations by year
- 2026: 23 · 2025: 26 · 2024: 31 · 2023: 30 · 2022: 23 · 2021: 24 · 2020: 32 · 2019: 29 · 2018: 22 · 2017: 25 · 2016: 34 · 2015: 27 · 2014: 19 · 2013: 26 · 2012: 38
- FWCI
- 6.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
- Keywords
- major lower extremity amputation, transtibial amputation, transfemoral amputation, amputation mortality, long-term survival, wound infection, cardiac complications, pneumonia, guillotine amputation, diabetes mellitus, end-stage renal disease, postoperative complications, sepsis control, reoperation
- MeSH terms
- Adult, Aged, Aged, 80 and over, Amputation, Surgical, Diabetes Mellitus, Female, Heart Diseases, Humans, Ischemia, Kidney Failure, Chronic, Male, Middle Aged, Pneumonia, Reoperation, Retrospective Studies, Surgical Wound Infection, Comorbidity, Survival Analysis, Treatment Outcome, Lower Extremity
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