Major lower extremity amputations : outcomes, complications, and patient perspectives

An amputation is considered to be one of the oldest surgical procedures; yet, despite advancements in medical care, it continues to be associated with high rates of complications and postoperative mortality. This thesis aims to shed light on the complications, outcomes, and patient perspectives surrounding major lower extremity amputations (LEA). Study I investigated mortality rates following the first-ever transfemoral amputation (TFA) at 1 week and 1 year, focusing on the potential influence of diabetes. A total of 162 individuals who underwent their first-ever TFA between 1996 and 2012 were included. Diabetes was present in 30 patients (19%). Mortality rates were notably higher for patients with diabetes compared to those without at both 1 week (30% versus 8%, p = 0.001) and 1 year (80% versus 57%, p = 0.02). This difference remained significant after conducting a multivariable analysis. Study II examined and compared outcomes after two different reamputation levels following a failed transtibial amputation (TTA) – TFA and knee disarticulation (KD). The primary outcomes were further reoperation and reamputation. A total of 152 patients were included, with 66 cases of KD and 86 cases of TFA. Following KD, the reamputation rate was 36% compared to 15% after TFA (p = 0.004). In the multivariable analysis, TFA was associated with a decreased risk of reamputation, with an odds ratio of 0.31 (95% CI 0.14 – 0.69). The reoperation rate was 22% after TFA, compared to 38% after KD (p = 0.03). Prosthetic fitting was achieved in 30% of KD cases and 19% of TFA cases (p = 0.1), however, this was not statistically significant. Mortality did not significantly differ between the two reamputation levels. Study III analyzed the impact on days to prosthesis after the implementation of a new guideline for transtibial amputations. We included 263 TTA patients after the new guideline was implemented and compared them against 169 patients undergoing TTA before the new guideline. Following the implementation of the new guideline, ...