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.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: August 11, 2021
Footnotes
Financial Disclosure: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflict of Interest: None reported.
Identification
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© 2021 by the American College of Foot and Ankle Surgeons. All rights reserved.
