Risk Factors for 30-Day Postoperative Complications and Mortality after Below-Knee Amputation: A Study of 2,911 Patients from the National Surgical Quality Improvement Program
Journal of the American College of SurgeonsPublished 5 July 2011
Philip J. Belmont, Shaunette Davey, Justin D. Orr, Leah M. Ochoa, Julia Bader, Andrew J. Schoenfeld
Citations153
SJR quartileQ1
SJR score1.23
SNIP1.35
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
Renal disease, cardiac issues, history of sepsis, steroid use, COPD, and increased patient age were identified as predictors of mortality after below-knee amputation.
Abstract
Renal disease, cardiac issues, history of sepsis, steroid use, COPD, and increased patient age were identified as predictors of mortality after below-knee amputation. Renal disease, cardiac issues, history of sepsis, steroid use, contaminated/infected wounds, and alcohol use were also found to be predictors of postoperative complications.
Keywords
MedicineEngineering
The LancetThe global burden of diabetic foot disease
2,483 Citations2005Andrew J.M. Boulton, Loretta Vileikytė +2 more
When assessing the economic effects of diabetic foot disease, it is important to remember that rates of recurrence of foot ulcers are very high, being greater than 50% after 3 years.
Journal of the American College of SurgeonsToward Robust Information: Data Quality and Inter-Rater Reliability in the American College of Surgeons National Surgical Quality Improvement Program
1,270 Citations2009Mira Shiloach, Stanley K. Frencher +7 more
Audit results show that data have been reliable since the program's inception and that reliability has improved every year, and Estimated kappa values suggest substantial or almost perfect agreement for most variables.
Southern Medical JournalLimb Amputation and Limb Deficiency: Epidemiology and Recent Trends in the United States
815 Citations2002Timothy R. Dillingham, Liliana E. Pezzin +1 more
The risk of amputations increased with age for all causes and was highest among blacks having dysvascular amputations, particularly among elderly and minority populations, and warrants further investigation.
CirculationIntermittent Claudication
673 Citations1997Joanne M. Murabito, Ralph B. D’Agostino +2 more
The intermittent claudication risk profile allows physicians to identify high-risk individuals during a routine office visit and can be used to educate patients about modifiable risk factors, particularly smoking and blood pressure.
Annals of SurgerySuccessful Implementation of the Department of Veterans Affairs’ National Surgical Quality Improvement Program in the Private Sector: The Patient Safety in Surgery Study
553 Citations2008Shukri F. Khuri, William G. Henderson +10 more
The VA NSQIP methods and risk models in general and vascular surgery were fully applicable to private sector hospitals and 30-day postoperative morbidity or mortality in PS hospitals was reduced with the implementation of theNSQIP.
Archives of SurgeryMajor Lower Extremity Amputation
508 Citations2004Bernadette Aulivola
Long-term survival is dismal for patients with DM and end-stage renal disease and those undergoing AKA, and Survivors with BKA require revision or conversion to AKA infrequently.
Archives of Physical Medicine and RehabilitationReamputation, mortality, and health care costs among persons with dysvascular lower-limb amputations
352 Citations2005Timothy R. Dillingham, Liliana E. Pezzin +1 more
Although diabetic amputees were less likely to die within 12 months of the index amputation, they died at a significantly younger age than their nondiabetic counterparts, and there were marked differences in patient characteristics, progression of amputation to higher levels, service use, and mortality among dysvascular amputee with and without a comorbidity of diabetes.
Diabetic MedicineDecreasing Incidence of Major Amputation in Diabetic Patients: a Consequence of a Multidisciplinary Foot Care Team Approach?
343 Citations1995J. Larsson, Anders Stenström +2 more
A substantial long‐term decreases in the incidence of major amputations was seen as well as a decrease in the total incidence of amputations in diabetic patients, indicating that a multidisciplinary approach plays an important role to reduce and maintain a low incidence of majors.
Journal of the American College of SurgeonsGeneral Surgical Operative Duration Is Associated with Increased Risk-Adjusted Infectious Complication Rates and Length of Hospital Stay
337 Citations2009Levi Procter, Daniel L. Davenport +2 more
Operative duration is independently associated with increased ICs and LOS after adjustment for procedure and patient risk factors in a broad range of general surgical procedures.
The American Journal of SurgeryPrevention of amputation by diabetic education
315 Citations1989James Malone, Martin Snyder +4 more
It is demonstrated that a simple education program significantly reduced the incidence of ulcer or foot and limb amputation in diabetic patients.
Journal of Vascular SurgeryFunctional outcome in a contemporary series of major lower extremity amputations
311 Citations2003Mark R. Nehler, Joseph Coll +10 more
It is found that vascular patients in a contemporary setting who require major lower extremity amputation and rehabilitation often remain independent despite infrequent prosthesis use and outdoor ambulation, and ability to predict ambulation after BKA in the vascular population is poor.
Journal of Bone and Joint SurgeryNutrition in orthopaedic surgery.
274 Citations1982Janne Jensen, T G Jensen +3 more
A significant correlation between subnormal nutritional indices and the development of complications was identified and a comprehensive approach to the detection and correction of malnutrition in orthopaedic patients is described.
Journal of Bone and Joint SurgeryNutritional status
252 Citations1984S C Dickhaut, Jesse C. DeLee +1 more
In this study, the influence of preoperative nutritional status on morbidity in twenty-three diabetic patients who underwent a Syme amputation was examined.
Diabetes CareGeographic Variation of Lower-Extremity Major Amputation in Individuals With and Without Diabetes in the Medicare Population
247 Citations2001James S. Wrobel, Jennifer A. Mayfield +1 more
Diabetes-related amputation rates exhibit high regional variation, even after age, sex, and race adjustment, and future work should be directed to exploring sources of this variation.
Diabetes CareReduction in Diabetes-Related Lower-Extremity Amputations in the Netherlands: 1991–2000
220 Citations2004William H. van Houtum, Jan A. Rauwerda +3 more
Over the years observed in this study, the incidence rates of diabetes-related lower-extremity amputation in The Netherlands was found to decrease in both men (36%) and women (38%) with diabetes, and the duration of hospitalization decreased over time.
The American Journal of SurgeryMajor lower extremity amputations at a Veterans Affairs hospital
168 Citations2003Carlos P. Cruz, John F. Eidt +3 more
The data suggest that major lower extremity amputations highlight a very high-risk population with only 39% survival at 7 years, as well as a costly subset secondary to prolonged hospitalization times, in addition to the extraordinary cost associated with diminished functional status.
SurgeryPostoperative and late survival outcomes after major amputation: Findings from the Department of Veterans Affairs National Surgical Quality Improvement Program
168 Citations2001Joe Feinglass, William H. Pearce +7 more
A generic surgical risk model can be of use in stratifying prognosis after major amputation for older veterans who underwent above- or below-knee amputations in 119 Veterans Affairs (VA) hospitals from 1991 to 1995.
Diabetes CareDiabetes and Lower-Limb Amputations in the Community: A retrospective cohort study
153 Citations1998Andrew D. Morris, Ritchie McAlpine +9 more
These population-based U.K. amputation data are similar to amputation rates in the U.S. and appear to have decreased significantly since 1980–1982, which means the impact of diabetes education and prevention programs that target the processes leading to amputations can now be evaluated.
American Journal of Public HealthRates of lower-extremity amputation and arterial reconstruction in the United States, 1979 to 1996.
151 Citations1999Joe Feinglass, Janine L. Brown +5 more
Major amputation rates fell in the years following the diffusion of distal bypass surgery but before the widespread use of peripheral angioplasty, and the rate of major amputation has increased since 1993.
Diabetes CareRisk Factors for Lower Extremity Amputation in Persons With Diabetes
146 Citations1995Joe V. Selby, Danya Zhang
Level of glucose control, duration of diabetes, and baseline systolic blood pressure were independent predictors of amputation, as were microvascular complications (retinopathy, neuropathy, and nephropathy), and history of stroke, but not myocardial infarction, was also independently predictive.
Diabetes Research and Clinical PracticeDisease management for the diabetic foot: Effectiveness of a diabetic foot prevention program to reduce amputations and hospitalizations
144 Citations2005Lawrence A. Lavery, Robert P. Wunderlich +1 more
A population-based screening and treatment program for the diabetic foot can dramatically reduce hospitalizations and clinical outcomes.
European Journal of Vascular and Endovascular SurgeryContemporary Series of Morbidity and Mortality after Lower Limb Amputation
144 Citations2005A.J. Ploeg, Jan Willem H. P. Lardenoye +2 more
Major lower extremity amputations are still associated with considerable morbidity and mortality and an extensive registration system provides a detailed insight into the incidence, consequence and cause of complications.
PubMedSurvival following lower-limb amputation in a veteran population.
127 Citations2001Jennifer A. Mayfield, Gayle E. Reiber +4 more
Survival following lower-limb amputation is impaired by advancing age, cardiovascular and renal disease, and proximal amputation level, and a small survival advantage is seen for African Americans and those with diabetes.
Medical CareDifferences in Patient Characteristics Between Veterans Administration and Community Hospitals
124 Citations1987Malcom Randall, Kerry E. Kilpatrick +3 more
Journal of the American College of SurgeonsRisk Adjustment in the American College of Surgeons National Surgical Quality Improvement Program: A Comparison of Logistic Versus Hierarchical Modeling
114 Citations2009Mark E. Cohen, Justin B. Dimick +4 more
When applied to ACS-NSQIP data, logistic and hierarchical models provided nearly identical results with respect to identification of hospitals' observed-to-expected events ratio outliers as logistic regression will remain an accurate and efficient method for performing risk adjustment of hospital quality comparisons.
Anesthesia & AnalgesiaPerioperative and Long-Term Morbidity and Mortality After Above-Knee and Below-Knee Amputations in Diabetics and Nondiabetics
112 Citations2005Balachundhar Subramaniam, Frank B. Pomposelli +2 more
AKA should be triaged as a high-risk surgery while BKA is an intermediate- risk surgery, regardless of the presence of diabetes mellitus, and long-term survival after AKA or BKA are poor,Regardless of the existence of DM.
ANZ Journal of SurgeryOUTCOMES OF A CONTEMPORARY AMPUTATION SERIES
108 Citations2006Tao Shan Lim, Andrew Finlayson +6 more
The aim of this study was to determine the outcomes of a contemporary amputation series and to establish a baseline level of confidence in the ability of these procedures to be performed in the future.
Journal of Vascular SurgeryImpact of arterial surgery and balloon angioplasty on amputation: A population-based study of 1155 procedures between 1973 and 1992
92 Citations1997John W. Hallett, John Byrne +4 more
It is concluded that increased vascular surgery and balloon angioplasty rates have coincided with a significant reduction in major amputation rates in the past 10 years.
Journal of Vascular SurgeryFunctional status and walking ability after lower extremity bypass grafting or angioplasty for intermittent claudication: Results from a prospective outcomes study
76 Citations2000Joe Feinglass, Walter J. McCarthy +3 more
Most of the functional improvement achieved by patients who underwent interventional management appears to be related to improved patency rather than to selection bias or placebo effects.
Journal of Vascular SurgeryA census-based analysis of racial disparities in lower extremity amputation rates in Northern Illinois, 1987-2004
72 Citations2008Joe Feinglass, Shabir Abadin +2 more
Racial disparities in lower extremity amputation rates have remained remarkably constant, despite progress in reducing the overall major amputation rate in northern Illinois.
The American SurgeonMajor Lower-Extremity Amputation: Contemporary Experience in a Single Veterans Affairs Institution
70 Citations2002Boulos Toursarkissian, Paula K. Shireman +4 more
A retrospective review of sequential amputations at one Veterans Affairs institution found that despite an acceptable perioperative mortality complication rates remain high especially in nonwhites, low rehabilitation rates especially in dialysis patients mandate further efforts in this regard.
The American Surgeon“Successful Outcome” after Below-Knee Amputation: An Objective Definition and Influence of Clinical Variables
56 Citations2008Spence M. Taylor, Corey A. Kalbaugh +5 more
Patients without predictors of failure possess a high potential for rehabilitation, whereas patients with multiple predictors rarely rehabilitate, should probably receive palliative above-knee amputation, and forgo the expense of futile prosthetic training.
The Journal of Rehabilitation Research and DevelopmentRisk factors associated with mortality in veteran population following transtibial or transfemoral amputation
53 Citations2006Barbara Bates, Margaret G. Stineman +3 more
High medical complexity and mortality rates attest to the need for careful medical oversight during the postacute rehabilitation period among veterans following transfemoral amputations, transtibial amputation, or hip disarticulation.
Journal of the American College of SurgeonsSurvival after lower-extremity amputation1,2
53 Citations2004Diana Kovacich Sandnes, Michael Sobel +1 more
Longterm survival after amputation has improved considerably with time in the state of Washington, and the reasons underlying this improvement should be explored so that further gains may be achieved.
Journal of Vascular SurgeryNoninvasive determination of healing of major lower extremity amputation: The continued role of clinical judgment
46 Citations1988Willis H. Wagner, Blair A. Keagy +3 more
It is concluded that the skin temperature and tcPO2 obtained at the site of proposed amputation were the most reliable prognostic noninvasive examinations.
PubMedLower extremity amputation: a contemporary series.
31 Citations2008Patrick A. Stone, Sarah K. Flaherty +2 more
Early vascular surgery referral may reduce more proximal amputations and improve functional outcome in a group with poor longevity and limited functional capacity with amputation at the transtibial level and proximal.
World Journal of SurgeryAn Analysis of Risk Factors Associated with Failure of Below Knee Amputations
28 Citations2006Vincent Yip, Nee Beng Teo +5 more
It is suggested that CRPFTL and postoperative WI are predictor variables for the failure of a BKA and there is the potential role of arteriogram scoring in predicting the outcome of aBKA.
PubMedLower extremity amputation in Hong Kong.
12 Citations2005Margaret W.N. Wong
Lower extremity amputation is associated with high morbidity and mortality, especially with high-level amputations, and Appropriate health care planning, provisions, and coordinated efforts at various levels are necessary to improve the situation.