Study cites factors linked with increased reoperation after above-knee amputation

There is an increased chance for unplanned reoperation in patients who underwent above-knee amputation if they had prior revascularization, multiple indications for amputation and postoperative wound complications, according to a recently published study.

Researchers performed a retrospective review of 155 patients who underwent a total of 185 above-knee amputations. Data on standard demographics, comorbidities, perioperative data and postoperative data were collected. Investigators also calculated Pearson x2 tests, Fisher exact tests and logistic regression models.

Results showed tissue loss, rest pain, infection or two or more indications were among the reasons for amputation. Investigators noted 75 patients underwent prior ipsilateral revascularization and 75 patients underwent prior ipsilateral amputation. Out of the revascularization procedures, 22 procedures were due to ipsilateral arterial inflow; although, this was not associated with wound healing. The unplanned reoperation rate was 15.7%. Most reoperations were due to soft tissue wound revision and other reasons included reamputation with a more proximal osteotomy and hip disarticulation. At 30 days the all-cause mortality rate was 11.3% and at 1 year it was 52.5%.

According to researchers, prior ipsilateral revascularization, history of coronary artery disease, multiple reasons for amputation, presence of postoperative complication, postoperative wound infection, wound dehiscence and hematoma were among the independent risk factors for reoperation on univariate analysis. Risk factors for reoperation on multivariate regression included prior ipsilateral revascularization, multiple reasons for amputation, postoperative hematoma and wound dehiscence. There was no association between reoperation and an increase in overall mortality. – by Monica Jaramillo

Disclosures: Edwards reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.

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Edwards JB, et al. JAMA Surg. 2019;doi:10.1001/jamasurg.2018.5074