"Not so minor" - Digital Amputation as a precursor to Major Amputation and Mortality in an Irish tertiary vascular centre.

BACKGROUND

Minor (toe) amputations are a common consequence of peripheral arterial disease (PAD) and/or diabetes. They can herald further forefoot and major amputations and are a poor prognostic indicator for five-year survival. This study aimed to identify prognostic indicators for progression from minor amputation to major amputation and all-cause mortality.

METHODS

Index digital amputations performed by vascular surgeons in a tertiary referral hospital between 2017-2022 were identified from Hospital In-Patient Enquiry (HIPE) data. Electronic records for each limb were followed up to October 2025 for further ipsilateral minor and major amputations and mortality.

RESULTS

224 limbs in 209 patients underwent at least one minor amputation. The cohort was predominantly male (86%) with a mean age of 66.3 years (± 12.7). 70% had PAD and 80% had diabetes. In total, 34% (n=73/215) required further ipsilateral amputation, 78.3% of which occurred within 12 months of index surgery. Minor and major re-amputation rates were 25.6% and 11%, respectively. Predictors of further amputation at any level included ischaemic heart disease (IHD) (OR 2.796, 95% CI 1.54-5.06), diabetes (OR 2.31, 95% CI 1.04-5.136) and dialysis (OR 2.20, 95% CI 1.021-4.915). Index hallux amputation, IHD, and revascularisation at index admission were risk factors for further major ipsilateral amputation. All-cause mortality was 11.4%, 24.8% and 48% at one, three and five years, respectively.

CONCLUSION

Consistent with international data, minor amputations are poor prognostic factor for limb loss and death. In this cohort, patients with IHD and dialysis were most at risk for further amputation.