|Delaying major amputation increases death rates|
|Monday, 04 March 2013|
Moxey PW, Hofman D, Hinchliffe RJ et al. Delay influences outcome after major lower limb amputation. Eur J Vasc and Endovasc Surg 2012; 44: 485-90.
In a nutshell
Of the major amputations, 14,168 were identified during the study period. The ratio of above-knee to below-knee amputations was 1:1 (with a very small proportion of through-knee amputations). Only 9.1% of all patients had some attempt at revascularisation prior to the major amputation during the index admission. The in-hospital mortality rate was 17% and the one year mortality rate was 35.4%.
Male in-hospital mortality increased by 2% for every day of delay of amputation surgery (OR 1.02; p<0.0001). The median length of wait between admission and major amputation was 11 days. Recovery time also increased significantly with delays in amputation surgery in both males and females. Previous bypass or bypass and angioplasty significantly increased mortality rates whereas angioplasty had no effect on mortality.
The study highlights the low proportion of patients undergoing revascularisation prior to major amputation during the index admission but no information is given about whether prior attempts had been made during previous admissions.
The study also highlights the high in-hospital mortality associated with major amputation surgery.