Objectives: Multiple surgical disciplines are capable of performing and managing urgent or emergent major lower extremity amputations (LEA). It is established that outcomes for this patient population are quite variable based on comorbid conditions and frailty. This study seeks to determine if the primary surgical service performing major LEA affects re-amputation rates, ambulation status, or mortality-based outcomes.
Methods: We conducted a retrospective chart review of 464 patients who received major lower extremity amputations at our institution between November 2015 and October 2021. Frailty was calculated with the 5-factor modified Frailty index (mFI-5) and patients were categorized into frail or non-frail. Post-amputation outcomes including post-operative ambulation with prosthesis, 30-day and 1 year re-amputation, and 30-day and 1 year mortality were recorded and compared between vascular, orthopedic, and trauma surgery services. Statistical analysis was performed for outcome measures and p-value of < 0.05 was considered significant.
Results: Vascular surgeons performed 219 cases (51.4%), orthopedic surgeons performed 75 cases (17.6%), and trauma surgeons performed 132 cases (31%). Open, or guillotine amputations were performed by all services evaluated. There were 361 non-frail patients in this cohort. Within the non-frail group, 68% of trauma surgery patients got re-amputated in 30 days, followed by 61% of orthopedic surgery patients, and 58.7% of vascular surgery patients (p < 0.001). Orthopedic surgery had the highest rates of patients who achieved post-operative ambulation with a prosthesis, followed by vascular surgery, and trauma surgery (68.3% vs. 35% vs. 33.7%, p< 0.001). There were no differences between surgical specialties in 30-day and 1 year mortality and 1 year re-amputation. There were no differences between surgical specialties in 30-day and 1 year mortality, 30-day and 1 year re-amputation, and post-operative ambulation with a prosthesis in the 103 frail patients.
Conclusion: In non-frail patients, the surgical specialty performing the lower extremity amputation had an effect on post-operative outcomes. In frail patients, post-operative outcomes were dependent on comorbid conditions more so than surgical service.
