Descriptive Analysis of Patients Undergoing Major Lower Extremity Amputation in the Vascular Quality Initiative

Abstract

Introduction and Objectives: Despite an aggressive climate of limb salvage and revascularization, 7% of patients with peripheral artery disease (PAD) undergo major lower extremity amputation (LEA). The purpose of this study was to describe the current demographics of patients undergoing major LEA in the Vascular Quality Initiative (VQI). Methods: The VQI amputation registry was reviewed to identify patients who underwent major LEAs. Patient factors, limb characteristics, procedure type, and intraoperative variables were analyzed by level of amputation using chi-square analysis for significance with associated pvalues. Results: Between 2013-2015, 3,180 major LEAs were completed with a BKA:AKA ratio of 1.29:1. Mean age was 66 years, 85% living at home prior to admission, and 68% ambulatory. Co-morbidities included diabetes (67%), CAD (32%), ESRD (22%), and COPD (23%). Mean ABI was 0.78, with 28% history of ipsilateral revascularization. Indications were ischemic rest pain or tissue loss (58%), uncontrolled infection (31%), acute ischemia (9%), and neuropathic tissue loss (2%). Post-operatively, 28% were discharged home, complication rate was 16%, and 30-day mortality 6%. Patients who received an AKA vs BKA were more likely female (40.45% vs 31.67%), >70 years (47.95% vs. 32.81%), underweight (18.42% vs. 9.34%), non-ambulatory (40.41% vs 25.11%), ASA class >3 (53.84% vs 43.78%), ABI <0.6 (58.38% vs. 43.78%), and non-private insurance (77.88% vs 69.5%). Patients undergoing AKA were less likely to have post-operative complications (13% vs 18%), but had higher 30-day mortality (9% vs 5%)(All P<0.001). Conclusions: In the VQI registry, major LEA was performed predominantly for ischemic rest pain and tissue loss with a BKA:AKA ratio of 1.29:1. Patients undergoing AKA vs BKA were older, more frail, had lower ABI, fewer post-operative complications, but higher 30-day mortality. This registry offers an important real world resource for studies pertaining to vascular surgery patients undergoing major lower extremity amputation.