Factors Associated With Unplanned Reoperation After Above-Knee Amputation | Orthopedics | JAMA Surgery | JAMA Network
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    1 Comment for this article
    Risk Stratification
    Steven Zeitzew, M.D. | West L.A. VA Healthcare Center
    Although largely left unstated the article argues for further studying the results after risk stratification and medical optimization. It would be instructive to know more about the risk factors present prior to amputation surgery and more about the data used for surgical decision making. It is interesting to note the higher complication rate in those who continue to smoke. It might be useful to know how well diabetes was controlled and the TcPO2 results before surgery in both groups, if that data had been collected. Perhaps many amputations should be delayed and scheduled electively after additional medical optimization, such as smoking cessation, and improved diabetes control. Amputation level is better predicted by TcPO2 than by clinical examination. What were the results for the subgroup where those results were known, if there was one? The lost to follow up rate is surprising in a VA study since VA patients tend to stay in the system. It would be interesting to look at the VA subgroup to see if the results were different.
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    Research Letter
    February 6, 2019

    Factors Associated With Unplanned Reoperation After Above-Knee Amputation

    Author Affiliations
    • 1Department of Vascular Surgery, University of South Florida, Tampa
    • 2Department of Vascular Surgery, Medical University of South Carolina, Charleston
    • 3Department of Vascular Surgery, James A. Haley Veterans’ Affairs Hospital, Tampa, Florida
    JAMA Surg. 2019;154(5):461-462. doi:10.1001/jamasurg.2018.5074

    Above-knee amputation (AKA) is typically a last-resort procedure in patients who are not candidates for limb salvage. Unplanned reoperation has been identified as a risk factor for increased morbidity and hospital readmission after vascular surgery.1 The objective of this study was to evaluate risk factors for unplanned reoperation after AKA.

    A retrospective review was performed that included all patients who underwent 1 or more AKA by the vascular surgery service at 2 hospitals from January 1, 2013, to December 31, 2015. The level of amputation was determined by clinical examination, because adjunctive measures of tissue perfusion (ie, transcutaneous oximetry) were not used by these centers during this period. Data collected included standard demographics and comorbidities, perioperative data, and postoperative outcomes.