Undernutrition Is Associated With Higher Rate of Reamputation or Mortality, Lower Mobility, and Lower Quality of Life After Dysvascular Major Lower Limb Amputation: A Longitudinal Observational Study.

OBJECTIVE

To investigate the association between undernutrition and survival, reamputation-free survival, quality of life (QoL), wound healing, mobility, and work status postdysvascular major lower limb amputation (LLA).

DESIGN

Longitudinal observational multicenter study.

SETTING

At multiple settings, including hospitals, rehabilitation/care facilities, and at home.

PARTICIPANTS

Adults who have undergone dysvascular major LLA (N=81) in 2023, without severe malabsorption disease.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Participants' nutritional status (Patient-Generated Subjective Global Assessment) was assessed at <12 days, 5 weeks, 6 months, and 9 months post-LLA. Reamputation-free survival and QoL (World Health Organization Quality of Life Questionnaire-BREF) were assessed at 5 weeks, 6 months, and 9 months, wound healing at 5 weeks, mobility (K-level) at 6 and 9 months, and work status at 9 months post-LLA.

RESULTS

Eighty-one participants were included (mean age 69.7±10.5y; 73% men; 73% transtibial LLA). Participants who died (n=14) or required reamputation (n=4) were undernourished at <12 days post-LLA. Undernutrition was significantly associated with lower reamputation-free survival (χ2=3.976; P=.046) and lower physical and psychological QoL (B=-7.6; P=.003; B=-9.9; P<.001), but not with survival (χ2=2.637; P=.101) and impaired wound healing (OR, 1.88; P=.272). Undernutrition was significantly associated with lower mobility (K-level 0/1 vs 2/3/4; OR, 0.20; P=.035) at 6 months post-LLA, but not at 9 months (OR, 0.33; P=.303). Lower Patient-Generated Subjective Global Assessment score was significantly associated with longer survival and reamputation-free survival, and better QoL, higher mobility, and higher rates of employment/volunteering.

CONCLUSIONS

These findings highlight the relevance of undernutrition in the dysvascular major LLA population, and the critical need for nutritional interventions to prevent or limit undernutrition, with the potential to improve outcomes such as reamputation-free survival, QoL, and mobility.