Outcomes and risk factors for complications, readmissions, and reoperations following below-knee amputation: a comprehensive analysis beyond the 30-day window.

PURPOSE: This study evaluates the long-term outcomes following below-knee amputation (BKA), focusing on reoperations, readmissions, complications and mortality at 180 and 365 days. It aims to identify key risk factors and address the underreporting of long-term outcomes.

METHODS

This retrospective study analyzed adult BKA patients (2005-2022) at a Level I trauma center, analyzing demographics, surgical details, and comorbidities to assess long-term outcomes using statistical analyses (p < 0.05).

RESULTS

The study assessed 376 BKAs. Patients had a mean age of 51.4 years and body mass index (BMI) of 32.7 kg/m2. Complications occurred in 62.5% of cases; 28.2% had direct surgical complications, and 25.8% required unplanned reoperations. Readmission rates were 10.1% by 30 days, 29.8% by 180 days, and 32.98% by 365 days. Diabetes mellitus (DM) (OR 1.98; p = 0.0115) and insurance status were associated with increased readmission. Younger age (OR 0.96; p = 0.001) and employment status were associated with higher odds of direct complications, while diabetes (OR 2.47; p < 0.001) and poor glycemic control (A1c > 5.83%) predicted indirect complications. Mortality increased from 2.7% by 30 days to 17.0% by 1 year and was independently associated with cancer (OR 4.37; p = 0.005), myocardial infarction (MI), chronic obstructive pulmonary disease (COPD), peripheral vascular disease (PVD), and prior vascular intervention (VI).

CONCLUSION

A substantial proportion of BKA complications and deaths occur beyond 30 days. Risk-tailored perioperative management and extended follow-up are essential to improving patient outcomes and reducing long-term healthcare burdens.