Prosthetic Outcomes after Amputation and the Impact of Mobility Level on Survival

William Shutze; Dennis Gable; Gerald Ogola; John Eidt

doi:10.1016/j.jvs.2024.04.046

Prosthetic Outcomes after Amputation and the Impact of Mobility Level on Survival

J Vasc Surg. 2024 Apr 24:S0741-5214(24)01071-1. doi: 10.1016/j.jvs.2024.04.046. Online ahead of print.

Authors

William Shutze¹, Dennis Gable², Gerald Ogola³, John Eidt⁴

Affiliations

¹ The Heart Hospital Baylor Plano, Plano, TX; Texas Vascular Associates, Plano, TX. Electronic address: willshut@sbcglobal.net.
² The Heart Hospital Baylor Plano, Plano, TX; Texas Vascular Associates, Plano, TX.
³ Baylor Scott and White Research Institute, Dallas, TX.
⁴ Texas Vascular Associates, Plano, TX; Baylor University Medical Center, Dallas, TX.

PMID: 38670323
DOI: 10.1016/j.jvs.2024.04.046

Abstract

Background: Lower extremity amputation continues to be necessary in a significant number of patients with peripheral vascular disease. The 5 year survival following lower limb loss is markedly reduced. Many of these patients are never fitted with a prosthesis and there is a dearth of knowledge regarding the barriers to prosthetic attainment. The goal of this study was to identify the risk factors for not receiving a prosthesis and the effect of mobility level on survival following major amputation.

Methods: This was a retrospective analysis of all patients that underwent lower-extremity amputation by surgeons in our practice from January 1, 2010 to December 31, 2019. Abstracted data included: age, sex, race, body mass index (BMI), comorbidities, American Society of Anesthesiologists (ASA) score, statin use, level of amputation, stump revision, fitting for prosthesis, type of prosthesis, and the United States' Medicare Functional Classification Level (MFCL) also called K level. Survival was determined using a combination of sources, including the Social Security Death Master File, searches of multiple genealogic registries and general internet searches. Multivariable logistic regression was used to determine risk factors associated with prosthesis attainment. Multivariable Cox proportional hazard regression with time dependent covariates was performed to assess risk factors associated with 5-year mortality.

Results: 464 patients were included in this study. The mean age was 65 years and mean body mass index 27 kg/m². Majority of patients were male (68%), white (56%), diabetic (62%), and hypertensive (76%), and underwent below-the-knee amputation (BKA) (69%). Prosthetic attainment occurred in 185 (40%). On multivariable analysis age >81 years and current tobacco use were associated with no prosthetic fitting. Overall 5-year survival was 41.9% (95%CI, 37.6%-46.6%) (BKA 47.7% [95%CI, 42.5%-53.5%], above-the-knee amputation 28.7 % [95%CI, 22.1%-37.2%]). On multivariable analysis age >60 years, CHF, AKA and no prosthetic attainment were associated with decreased survival. Increasing K level was incrementally associated with improved survival.

Conclusion: This study has identified several patient factors associated with prosthetic attainment, as well as multiple factors predictive of reduced survival after amputation. Being referred for prosthetic fitting was associated with improved survival not explained by patient characteristics and comorbidities. The MFCL K level predicts survival. More research is needed to determine the barriers to prosthetic attainment and if improving a patients K level will improve survival.