The Timing of Limb Amputation in Nontraumatic Patients: Impact on Mortality and Postoperative Complication Rates

Shani Shamir; Yuval Schwartz; Daniel Cohen; Tali Bdolah-Abram; Amos M Yinnon; Yonit Wiener-Well

doi:10.1053/j.jfas.2021.08.002

The Timing of Limb Amputation in Nontraumatic Patients: Impact on Mortality and Postoperative Complication Rates

J Foot Ankle Surg. 2022 Mar-Apr;61(2):293-297. doi: 10.1053/j.jfas.2021.08.002. Epub 2021 Aug 12.

Authors

Shani Shamir¹, Yuval Schwartz², Daniel Cohen³, Tali Bdolah-Abram⁴, Amos M Yinnon⁵, Yonit Wiener-Well⁶

Affiliations

¹ Resident, Infectious Disease Unit, Shaare Zedek Medical Center, Affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel.
² Fellow, Infectious Disease Unit, Shaare Zedek Medical Center, Affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel.
³ Orthopedic Surgeon, Department of Orthopedics, Shaare Zedek Medical Center, Affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel.
⁴ Statistician, Shaare Zedek Medical Center, Affiliated With the Hebrew University-Hadassah Medical School, Jerusalem, Israel.
⁵ Professor, Infectious Disease Unit, Shaare Zedek Medical Center, Affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel; Professor, Division of Internal Medicine, Shaare Zedek Medical Center, Affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel.
⁶ Consultant, Infectious Disease Unit, Shaare Zedek Medical Center, Affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel. Electronic address: yonitw@szmc.org.il.

PMID: 34479777
DOI: 10.1053/j.jfas.2021.08.002

Abstract

Diabetes and peripheral vascular diseases are accompanied frequently by lower limb ischemia and in minority, need for amputation, as a treatment of last resort. Even after a decision has been made regarding amputation, the procedures are often repeatedly postponed due to more urgent surgeries and lack of operating room availability. This study assessed the possible relationship between the duration of time inpatients wait for semiurgent amputations and the incidence of postamputation complications. A retrospective cohort, including all 360 adult patients who underwent nontraumatic limb amputation due to an ischemic/gangrenous/infected foot in a single center during an 11-year period (2007-2017). Most (96%) of the procedures were major amputations. The mean waiting time until amputation was 3 ± 5 days. Mortality during hospitalization occurred in 101 (28%) patients and re-amputation in 38 (11%). The duration of antibiotic treatment was 11 ± 14 days. The rate of sepsis was 30% (107/360). There was no significant difference between the duration of time until amputation and mortality during hospitalization: among those who waited ≤48 hours, the mortality rate was 27% (60/224) and among those who waited >48 hours 30% (41/136) (p = .5). Patients waiting ≤48 hours had higher re-amputation rates than those waiting >48 (31/223 (14%) vs 7/136 (5%), p = .009). Mortality was associated significantly to patients' age and renal function. Correlation was found between the waiting time until amputation (≤48 or >48 hours) and the rates of in-hospital mortality, sepsis, duration of antibiotic treatment and overall duration of hospitalization. Re-amputation rate was higher in group with the shorter waiting time. This correlation may be explained by the fact that patients who needed urgent amputation had a more extensive and severe disease, and thus tended to require more re-amputation operations.

Keywords: amputation; delay; diabetes mellitus; mortality; peripheral vascular disease; postoperative complication.

MeSH terms

Adult
Amputation, Surgical* / adverse effects
Amputation, Surgical* / mortality
Foot* / surgery
Hospital Mortality
Humans
Length of Stay
Postoperative Complications* / epidemiology
Reoperation / statistics & numerical data
Retrospective Studies
Risk Factors
Sepsis / epidemiology
Time Factors
Time-to-Treatment*
Treatment Outcome