Determinants of Survival, Reamputation, and Prosthetic Use after Major Lower-Limb Amputation for Peripheral Artery Disease: A Retrospective Cohort Study.

BACKGROUND

Major lower limb amputation remains a necessary treatment for advanced peripheral artery disease and is associated with substantial mortality and functional limitation. This study aimed to identify clinical factors associated with mortality and rehabilitation outcomes following major lower limb amputation.

METHODS

A retrospective review was performed of all patients undergoing major lower limb amputation, above-the-knee (AK) or below-the-knee (BK), between June 2017 and December 2023. Demographic characteristics, comorbidities, amputation level, reamputation, prosthesis use, and mortality were analyzed. Cox regression models were used to identify predictors of mortality and amputation level. Associations were assessed using chi-squared and nonparametric tests where appropriate. Statistical significance was defined as P < 0.05.

RESULTS

A total of 585 patients were included (mean age, 72 years), with AK amputations accounting for 61%. Overall mortality was 45%, with a mean time to death of 325 days. At 5 years after major amputation, cerebrovascular disease, cardiac insufficiency, atrial fibrillation, active malignancy, and dialysis dependence were independently associated with increased mortality, while anticoagulant therapy was protective. Regarding amputation level, cerebrovascular disease, cardiac insufficiency, atrial fibrillation, and dementia were independently associated with a higher likelihood of undergoing AK rather than BK amputation. BK amputations were associated with higher reamputation rates (P < 0.001), but greater prosthesis use compared with AK amputations (38% vs. 14%). Five-year survival was higher after BK than AK amputation (63% vs. 51%).

CONCLUSION

BK amputation is associated with improved long-term survival and functional outcomes despite higher reamputation rates. Optimization of cardiovascular and renal comorbidities may improve survival following major lower limb amputation.