TY - JOUR
T1 - Transmetatarsal and Minor Amputation Versus Major Leg Amputation
T2 - 30-Day Readmissions, Reamputations, and Complications
AU - Jupiter, Daniel C.
AU - Beaino, Marc El
AU - LaFontaine, Javier
AU - Barshes, Neal
AU - Wukich, Dane K.
AU - Shibuya, Naohiro
PY - 2020/5/1
Y1 - 2020/5/1
N2 - Aims: The optimal level of lower-extremity amputation, particularly in diabetic patients with ulceration, is debated. Proximal amputations more greatly decrease function versus distal amputations, but healing and complication rates may differ between the 2 types. This study compares early postoperative outcomes after transmetatarsal and other partial foot amputations and major leg amputations. Methods: Data were derived from National Surgical Quality Improvement Program datasets covering 2012 to 2014. Outcomes studied include 30-day rates of readmission to hospital for wound complications. We matched the 2 types of amputation patients by propensity score to fairly compare between levels of amputation when either type of amputation might be indicated. The same analysis was then performed with emphasis on diabetic patients. Results: Major amputation patients were more likely to have dependent functional status, although their surgeries tended to be more complicated. Minor amputation patients had 2.5 times the odds of irrigation and debridement compared with major amputation patients, but only 0.49 and 0.47 times the odds of urinary tract infection or transfusion, respectively. Conclusions: Although short-term complications, readmissions, and reoperations were more common in distal amputation, UTI and the need for transfusion were higher in major amputation.
AB - Aims: The optimal level of lower-extremity amputation, particularly in diabetic patients with ulceration, is debated. Proximal amputations more greatly decrease function versus distal amputations, but healing and complication rates may differ between the 2 types. This study compares early postoperative outcomes after transmetatarsal and other partial foot amputations and major leg amputations. Methods: Data were derived from National Surgical Quality Improvement Program datasets covering 2012 to 2014. Outcomes studied include 30-day rates of readmission to hospital for wound complications. We matched the 2 types of amputation patients by propensity score to fairly compare between levels of amputation when either type of amputation might be indicated. The same analysis was then performed with emphasis on diabetic patients. Results: Major amputation patients were more likely to have dependent functional status, although their surgeries tended to be more complicated. Minor amputation patients had 2.5 times the odds of irrigation and debridement compared with major amputation patients, but only 0.49 and 0.47 times the odds of urinary tract infection or transfusion, respectively. Conclusions: Although short-term complications, readmissions, and reoperations were more common in distal amputation, UTI and the need for transfusion were higher in major amputation.
KW - 2
KW - below knee amputation
KW - complications
KW - diabetes mellitus
KW - reoperation
KW - transmetatarsal amputation
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U2 - 10.1053/j.jfas.2019.09.019
DO - 10.1053/j.jfas.2019.09.019
M3 - Article
C2 - 32354505
AN - SCOPUS:85083808348
VL - 59
SP - 484
EP - 490
JO - Journal of Foot and Ankle Surgery
JF - Journal of Foot and Ankle Surgery
SN - 1067-2516
IS - 3
ER -