Document Detail


Major lower-extremity amputation: contemporary experience in a single Veterans Affairs institution.
MedLine Citation:
PMID:  12132742     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Our objective is to describe our current experience with major lower-extremity amputation secondary to vascular disease. We conducted a retrospective review of sequential amputations over a 3-year period at one Veterans Affairs institution. One hundred thirteen amputations were performed in 99 men (age 70 +/- 11 years). Seventy-five per cent were diabetic and 23 per cent were on dialysis. Fifty-six per cent were primary amputations. The final AKA/BKA (above-knee to below-knee amputation) ratio was 3:2 and was not related to prior bypass, ethnicity, or dialysis status (P > 0.5). Forty-three per cent of amputations were BKAs in diabetics versus 26 per cent in nondiabetics (P = 0.08). The in-hospital and 30-day mortality rates were 2.6 and 8 per cent and were not related to amputation level (P = 0.76). Forty per cent experienced postoperative complications that were most frequently wound related (22%). Wound complications were more frequent with BKA than AKA (P = 0.04). At an average follow-up of 10 +/- 8 months only 65 per cent were alive. Although 51 per cent were discharged to rehabilitation units only 26 per cent regularly wore a prosthesis with 23 per cent ambulating. BKA patients were more likely to ambulate than AKA (34% vs 9%; P = 0.001), and dialysis patients were less likely to ambulate than nondialysis patients (5% vs 25%; P < 0.02). During follow-up 17 per cent of patients discharged with an intact contralateral limb required amputation of that limb and 7 per cent had bypass surgery on that limb. Complication rates were higher in African Americans and Hispanics than in whites (59%, 45%, and 23%, respectively; P < 0.001), although mortality and ambulation rates were similar. Despite an acceptable perioperative mortality complication rates remain high especially in nonwhites. One-year mortality is high. Low rehabilitation rates especially in dialysis patients mandate further efforts in this regard. Vigilant follow-up of the contralateral limb is essential.
Authors:
Boulos Toursarkissian; Paula K Shireman; Amy Harrison; Marcus D'Ayala; John Schoolfield; Mellick T Sykes
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American surgeon     Volume:  68     ISSN:  0003-1348     ISO Abbreviation:  Am Surg     Publication Date:  2002 Jul 
Date Detail:
Created Date:  2002-07-22     Completed Date:  2002-07-25     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0370522     Medline TA:  Am Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  606-10     Citation Subset:  IM    
Affiliation:
Section of Vascular Surgery, Audie Murphy Veterans Hospital, San Antonio, Texas, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Amputation* / adverse effects,  methods,  rehabilitation
Diabetes Complications
Hospitals, Veterans
Humans
Leg / blood supply*,  surgery*
Male
Peripheral Vascular Diseases / complications,  ethnology,  surgery*
Postoperative Complications
Renal Dialysis
Retrospective Studies
Texas

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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