Quick Take: Factors associated with unplanned reoperation after above-knee amputation

Unplanned reoperation is a significant source of morbidity and mortality in patients that have undergone above-knee amputation (AKA). While there are certain unifying features to this patient population, namely significant underlying vascular disease, the authors of this study aimed to identify risk factors for unplanned reoperation after AKA. In this retrospective cohort study, 185 AKA operations were performed in 155 patients. Researchers found that there was a 15.7% rate of unplanned reoperation, most often for a soft tissue wound revision (48%), followed by re-amputation with a more proximal osteotomy (45%) and hip disarticulation (7%). Independent risk factors for reoperation after multivariate regression included prior ipsilateral revascularization (OR 4.43, 95% CI 1.45 to 13.45, p=0.009), multiple indications for amputation (OR 6.44, 95% CI 1.52 to 27.32, p=0.01), postoperative hematoma formation (OR 17.82, 95% CI 1.41 to 22.68, p=0.02) and wound dehiscence (OR 7.99, 95% CI 1.88 to 36.87, p=0.005). Interestingly, reoperation was not associated with an increase in overall mortality in this study. In addition, neither anticoagulation nor serum albumin was found to be associated with reoperation. This study therefore shows that patients with wound complications are at the highest risk of reoperation after AKA. This study was limited in that there was a paucity of data surrounding patient metabolic risk factors, which may have also contributed to the risk of complications after the index surgery. Further research is needed to identify individuals at risk of experiencing wound complications.

Click to read the study in JAMA Surgery

Image: PD

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