Identifying the incidence of and risk factors for reamputation among patients who underwent foot amputation

Ann Vasc Surg. 2012 Nov;26(8):1120-6. doi: 10.1016/j.avsg.2012.02.011. Epub 2012 Jul 25.

Abstract

Background: Many patients who have lower-extremity amputations secondary to peripheral vascular disease or diabetes require reamputation eventually. This study was designed to identify the incidence of and risk factors for ipsilateral reamputation after forefoot amputation, to evaluate whether postoperative infection increases the risk of reamputation, and to evaluate whether the risk of reamputation was reduced by the duration of antimicrobial therapy after amputation.

Methods: A retrospective analysis of patients who underwent foot amputation for nontraumatic reason from January 2002 to December 2004 at the Veterans Affairs Pittsburgh Healthcare System was performed.

Results: Among 116 patients, 57 (49.1%) had ipsilateral reamputation within 3 years after their first surgeries; 78.9% received reamputation in the first 6 months; 53 (45.7%) died within 3 years; and 16 (13.8%) developed postoperative infections. Upper level of amputation, long duration of hospitalization, insulin-dependent diabetes, and gangrene on physical examination on admission were risk factors for reamputation in univariate analysis. Gangrene (odds ratio: 3.81, 95% confidence interval: 1.60-9.12, P = 0.003) and insulin-dependent diabetes (odds ratio: 2.93, 95% confidence interval: 1.26-6.78, P = 0.012) were risk factors in multivariate analysis. Postoperative infection did not increase the risk of reamputation. Longer than 2-week course of antibiotic use after amputation did not prevent reamputation.

Conclusions: Approximately one-half of patients required ipsilateral reamputation and died in 3 years. Gangrene on admission and history of insulin-dependent diabetes were significant risk factors (P = 0.003, P = 0.028). Long duration of antibiotic use after amputation and postoperative infection did not change the risk of reamputation.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Amputation* / adverse effects
  • Amputation* / mortality
  • Ankle Brachial Index
  • Anti-Infective Agents / administration & dosage*
  • Chi-Square Distribution
  • Diabetes Mellitus, Type 1 / mortality
  • Diabetes Mellitus, Type 1 / surgery
  • Diabetic Foot / diagnosis
  • Diabetic Foot / mortality
  • Diabetic Foot / surgery*
  • Disease-Free Survival
  • Drug Administration Schedule
  • Female
  • Forefoot, Human / blood supply
  • Forefoot, Human / pathology
  • Forefoot, Human / surgery*
  • Humans
  • Incidence
  • Kaplan-Meier Estimate
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Peripheral Vascular Diseases / diagnosis
  • Peripheral Vascular Diseases / mortality
  • Peripheral Vascular Diseases / surgery*
  • Reoperation
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Surgical Wound Infection / drug therapy*
  • Surgical Wound Infection / microbiology
  • Surgical Wound Infection / mortality
  • Time Factors
  • Treatment Outcome
  • United States / epidemiology
  • United States Department of Veterans Affairs

Substances

  • Anti-Infective Agents