Ana-Catarina Pinho-Gomes
University Hospital of South Manchester, UK
Title: Predictors of mortality following above knee amputation for lower limb ischaemia
Biography
Biography: Ana-Catarina Pinho-Gomes
Abstract
Background: Above Knee Amputation (AKA) is a last-resort operation with high post-operative morbidity and mortality. The aim of this study was to identify preoperative risk factors for mortality in patients undergoing AKA for lower limb ischaemia.
Methods: Medical records of all the patients who underwent AKA for limb-threatening ischaemia between the 1st September 2014 and the 31st December 2015 were retrospectively reviewed. Patients were followed-up until 31st January 2016.
Results: A total of 65 patients (33 male; median age 75 [IQR 65-82] years) were included. 54 were treated for critical limb ischaemia, and the remainder for acute ischaemia. Hypertension, ischaemia heart disease, chronic obstructive pulmonary disease and type 2 diabetes mellitus were common (prevalence of 71%, 37%, 40% and 47%, respectively). Median length of stay was 27 [IQR 17-56] days and the proportion of patients requiring long-term residential care significantly increased from admission to discharge (p=0.005).
In-hospital mortality was 17% (11 patients), in all cases due to septic complications, most commonly from respiratory and wound sources. 90-day mortality was 30% (19 patients). Heart failure (OR8.9 95%CI 2.1-36.8; p=0.003) and eGFR<30 (OR11.9 95%CI 1.4-101.6; p=0.023) were independent predictors for 90-day mortality. At a median follow-up of 7.5 [IQR 2-16] months, all-cause mortality was 38% (25 patients) and median survival was 60 [IQR 29-102] days.
Conclusions: AKA performed for limb-threatening ischaemia is associated with high morbidity and mortality and hence, it imposes a major health-care burden. Patients with renal impairment and heart failure on admission have a significantly increased mortality risk.