Factors Associated With Unplanned Reoperation After Above-Knee Amputation | Orthopedics | JAMA Surgery | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 35.175.212.130. Please contact the publisher to request reinstatement.
1.
Aziz  F, Lehman  EB, Reed  AB.  Unplanned return to operating room after lower extremity arterial bypass is an independent predictor for hospital readmission.  J Vasc Surg. 2016;63(3):678-87. doi:10.1016/j.jvs.2015.09.015PubMedGoogle ScholarCrossref
2.
O’Brien  PJ, Cox  MW, Shortell  CK, Scarborough  JE.  Risk factors for early failure of surgical amputations: an analysis of 8,878 isolated lower extremity amputation procedures.  J Am Coll Surg. 2013;216(4):836-842. doi:10.1016/j.jamcollsurg.2012.12.041Google ScholarCrossref
3.
Phair  J, DeCarlo  C, Scher  L,  et al.  Risk factors for unplanned readmission and stump complications after major lower extremity amputation.  J Vasc Surg. 2018;67(3):848-856. doi:10.1016/j.jvs.2017.08.061PubMedGoogle ScholarCrossref
4.
Hasanadka  R, McLafferty  RB, Moore  CJ, Hood  DB, Ramsey  DE, Hodgson  KJ.  Predictors of wound complications following major amputation for critical limb ischemia.  J Vasc Surg. 2011;54(5):1374-1382. doi:10.1016/j.jvs.2011.04.048PubMedGoogle ScholarCrossref
5.
Met  R, Janssen  LI, Wille  J,  et al.  Functional results after through-knee and above-knee amputations: does more length mean better outcome?  Vasc Endovascular Surg. 2008;42(5):456-461. doi:10.1177/1538574408316914PubMedGoogle ScholarCrossref
6.
Taylor  SM, Kalbaugh  CA, Blackhurst  DW,  et al.  Preoperative clinical factors predict postoperative functional outcomes after major lower limb amputation: an analysis of 553 consecutive patients.  J Vasc Surg. 2005;42(2):227-235. doi:10.1016/j.jvs.2005.04.015PubMedGoogle ScholarCrossref
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    1 Comment for this article
    EXPAND ALL
    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.
    CONFLICT OF INTEREST: None Reported
    READ MORE
    Views 618
    Citations 0
    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.

    ×