Predictors of Unplanned Re-operation After Above Knee Amputation
Jeffrey B Edwards1, Mathew D Wooster2, Thanh Tran1, Paul A Armstrong1, Neil Moudgill1, Murray L Shames1, James D Brooks1
1University of South Florida Morsani School of Medicine, Tampa, FL;2Medical University of South Carolina, Charleston, SC
Predictors of Unplanned Re-operation After Above-Knee Amputation
Background: Unplanned reoperation has been identified as an independent risk factor for increased morbidity/mortality, as well as for hospital readmission following surgical intervention. Above-knee amputation (AKA) is typically considered a last-resort procedure in the vascular surgery population with few viable alternatives should AKA fail. We sought to describe risk factors for unplanned reoperation after AKA.
Methods: Medical records were reviewed for all patients undergoing AKA at two tertiary referral centers between January 2013 to December 2015 (to ensure potential for a minimum of one year post operative data collection). Standard demographic and comorbidity data were collected in addition to reoperation and readmission rates, procedural data, and perioperative variables. Outcomes were analyzed using the SAS statistical software package to determine independent risk factors for reoperation. Pearson’s chi-square test, Fischer exact test, and logistic regression were utilized as indicated.
Results: Over the study period, 185 AKA were performed in 155 patients. Mean age was 65.5 (SD 13.3) years with 75.6% males. Indications for amputation included tissue loss (n = 58, 31.5%), rest pain (n = 21, 11.4%), infection (n = 72, 39.1%), or a combination of those (n = 33, 17.9%). Seventy-four patients had undergone prior ipsilateral open (83.8%) and/or endovascular intervention (55.4%), and 92 patients had a history of prior ipsilateral (81.5%) and/or contralateral (41.3%) amputation. There was a 15.8% rate of return to the operating room, with the most common procedure performed being an amputation revision (n= 13, 44.8%). Two patients required conversion to a hip disarticulation. Independent risk factors for reoperation on univariate analysis included prior ipsilateral open or endovascular revascularization, presence of any complication, post-operative wound infection, wound dehiscence, and hematoma. On multivariate regression, wound dehiscence (OR 8.7, P 0.0012), prior ipsilateral endovascular intervention (OR 5.1, P 0.0024), and post-operative hematoma (OR 46.7, P 0.0033) were found to be independent risk factors for unplanned reoperation following AKA.
Conclusion: Failure of AKA is a challenging clinical scenario with limited salvage options. Wound dehiscence and post-operative stump hematoma greatly increase the risk of re-operation. Surgeons should take steps to minimize risk of wound-related complications in this high-risk patient population.
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