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DOS Kongressen 2016 ·
233
Re-operations and mortality after major lower
extremity amputations
Morten Torrild Schmiegelow, Nikolaj Sode, Troels Riis, Jes Bruun Lauritzen,
Lindberg-Larsen Martin
Orthopedic, Bispebjerg Hospital
Background:
Re-operation rates after below-knee (BKA), through-knee and
above-knee amputations (AKA) within 90 days has been reported to be 30%,
34% and 9% respectively in our institution (feb.2009-feb.2013) (Sode 2013).
90 days mortality rates were 36% and 40% after through knee and AKA (Buch
2013).These results led to change in practice, with restricted indications for the
through-knee amputation procedure.
Purpose / Aim of Study:
To investigate re-operation rates and mortality
of the major lower extremity amputations performed in our institution after
change of practice.
Materials and Methods:
Cases were included in the period Jan 1, 2014 to Dec
31, 2015. Mortality and re-operations within 90 days of the index amputation
were registered through examination of medical records.
Findings / Results:
116 amputations in 115 patients were performed. 95 AKA
and 21 BKA and no through-knee amputations. Mean age was 69 years for
BKA and 78 years for AKA. 85.7% of the BKA and 59% of the AKA were male.
52% of the BKA patients and 67% of the AKA patients were current or previous
smokers. Mean Charlson comorbidity score was 4.8 in the BKA patients and 4.2
in the AKA patients. The re-operation rate after BKA was 33.3% (CI 17-55) (6
soft tissue revisions and 1 re-amputation) caused by necrosis (n=4) and infec-
tion (n=3). The re-operation rate after AKA was 6.3% (CI 3-13) (2 re-ampu-
tations, 4 soft tissue revisions) caused by necrosis (n=2) and infection (n=4).
The 90-days mortality rate was 0% after BKA and 44% (CI 35-54) after AKA.
Conclusions:
The re-operation rate of 33% after BKA is at the same level as
before change of practice and the re-operation rate of 6.3% after AKA is slightly
lower. Most of patients previously offered a through-knee amputation are now
offered an AKA with a lower re-operation rate. However, the mortality rate of
44% after AKA is the major challenge.
No conflicts of interest reported
184.