Can Early Post-Operative Scoring of Non-Traumatic Amputees Decrease Rates of Revision Surgery?

• Published in: Medicina (Kaunas, Lithuania) Vol. 60; no. 4; p. 565
• Main Authors: Brauckmann, Vesta, Block, Ole Moritz, Pardo, Jr, Luis A, Lehmann, Wolfgang, Braatz, Frank, Felmerer, Gunther, Mönnighoff, Sebastian, Ernst, Jennifer
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01.04.2024
• Subjects: Adult; Aged; Aged, 80 and over; Amputation; Amputation, Surgical - adverse effects; Amputation, Surgical - statistics & numerical data; Amputees - rehabilitation; Analysis; Atherosclerosis; Body mass index; Care and treatment; Codes; Comorbidity; Confidence intervals; Decision-making; Female; Health aspects; Hospitals; Humans; Hypertension; Infections; Information management; Lower Extremity - injuries; Lower Extremity - surgery; lower-limb amputation; Male; Medical records; Middle Aged; non-traumatic amputation; Patients; Prostheses; Reoperation - statistics & numerical data; Retrospective Studies; revision surgery; Risk Factors; scoring system; Statistics; Surgery; Wound healing; Wounds and injuries; Germany; revision surgery; non-traumatic amputation; lower-limb amputation; scoring system
• ISSN: 1648-9144; 1010-660X; 1648-9144
• DOI: 10.3390/medicina60040565

Medical registries evolved from a basic epidemiological data set to further applications allowing deriving decision making. Revision rates after non-traumatic amputation are high and dramatically impact the following rehabilitation of the amputee. Risk scores for revision surgery after non-traumatic lower limb amputation are still missing. The main objective was to create an amputation registry allowing us to determine risk factors for revision surgery after non-traumatic lower-limb amputation and to develop a score for an early detection and decision-making tool for the therapeutic course of patients at risk for non-traumatic lower limb amputation and/or revision surgery. : Retrospective data analysis was of patients with major amputations lower limbs in a four-year interval at a University Hospital of maximum care. Medical records of 164 patients analysed demographics, comorbidities, and amputation-related factors. Descriptive statistics analysed demographics, prevalence of amputation level and comorbidities of non-traumatic lower limb amputees with and without revision surgery. Correlation analysis identified parameters determining revision surgery. In 4 years, 199 major amputations were performed; 88% were amputated for non-traumatic reasons. A total of 27% of the non-traumatic cohort needed revision surgery. Peripheral vascular disease (PVD) (72%), atherosclerosis (69%), diabetes (42%), arterial hypertension (38%), overweight (BMI > 25), initial gangrene (47%), sepsis (19%), age > 68.2 years and nicotine abuse (17%) were set as relevant within this study and given a non-traumatic amputation score. Correlation analysis revealed delayed wound healing (confidence interval: 64.1% (47.18%; 78.8%)), a hospital length of stay before amputation of longer than 32 days (confidence interval: 32.3 (23.2; 41.3)), and a BKA amputation level (confidence interval: 74.4% (58%; 87%)) as risk factors for revision surgery after non-traumatic amputation. A combined score including all parameters was drafted to identify non-traumatic amputees at risk for revision surgery. : Our results describe novel scoring systems for risk assessment for non-traumatic amputations and for revision surgery at non-traumatic amputations. It may be used after further prospective evaluation as an early-warning system for amputated limbs at risk of revision.