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Chronic kidney disease predicts long-term mortality after major lower extremity amputation
Roland Assi1, Yorg Al Azzi2, Clinton D Protack1, Willis T Williams1, Michael R Hall1, Daniel J Wong3, Daniel Y Lu3, Penny Vasilas4, Alan Dardik1
1 Department of Surgery, Department of Veterans Affairs Connecticut Healthcare System, West Haven; Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
2 Department of Medicine, Mount Sinai Hospital, Icahn School of Medicine, New York, USA
3 Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
4 Department of Surgery, Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
Correspondence Address:
Alan Dardik
VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, Connecticut - 06516
USA
 Source of Support: This work was supported by the resources and the use
of facilities at the VA Connecticut Healthcare System, West Haven, CT; the
contents do not represent the views of the Department of Veterans Affairs
or the United States Government,, Conflict of Interest: None  | Check |
DOI: 10.4103/1947-2714.136910
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Background: Despite low peri-operative mortality after major lower extremity amputation, long-term mortality remains substantial. Metabolic syndrome is increasing in incidence and prevalence at an alarming rate in the USA. Aim: This study was to determine whether metabolic syndrome predicts outcome after major lower extremity amputation. Patients and Methods: A retrospective review of charts between July 2005 and June 2010. Results: Fifty-four patients underwent a total of 60 major lower extremity amputations. Sixty percent underwent below-knee amputation and 40% underwent above-knee amputation. The 30-day mortality was 7% with no difference in level (below-knee amputation, 8%; above-knee amputation, 4%; P = 0.53). The mean follow-up time was 39.7 months. The 5-year survival was 54% in the whole group, and was independent of level of amputation (P = 0.24) or urgency of the procedure (P = 0.51). Survival was significantly decreased by the presence of underlying chronic kidney disease (P = 0.04) but not by other comorbidities (history of myocardial infarction, P = 0.79; metabolic syndrome, P = 0.64; diabetes mellitus, P = 0.56). Conclusion: Metabolic syndrome is not associated with increased risk of adverse outcomes after lower extremity amputation. However, patients with chronic kidney disease constitute a sub-group of patients at higher risk of postoperative long-term mortality and may be a group to target for intervention. |
