IntroductionMajor limb amputations are commonly performed operations with a high mortality rate [1,2]. Previous studies have shown that a range of factors are related to postoperative mortality after amputation. This patient population is getting increasingly older with a greater number of signifi cant medical comorbidities. Age, diabetes, increased ASA grade, female sex, heart failure, systemic sepsis are among the factors associated with worse perioperative outcomes [1,3,4].Despite improvements in coordinated efforts among the disciplines, management of these patients perioperatively continues to be challenging for anesthesiologists. The physical Abstract Objective: Patients undergoing major limb amputations are often elderly, debilitated patients with comorbidities that increase their operative risks and postoperative morbidity and mortality rates. We, as anesthesiologists, aimed to underline the factors that are important in decision-making for the well-being of these patients in the preoperative period.Method: After Ethical Committee approval, data was collected retrospectively from fi les of patients who underwent major limb amputation surgeries in our hospital from January 2014 to March 2016. Patient characteristics, indications for amputation, anesthetic techniques and surgical procedures performed, perioperative complications, requirement of intensive care unit admissions, length of stay in Intensive Care Unit (LOS in ICU) and hospital together with mortality rates were recorded. The results were represented as numbers and percentage. Results:A total of 126 patients were evaluated in the study. The mean age was 68.1±15.9 years. ASA IV patients made up 46% of all. 87.3% had emergency surgeries. The median waiting time before operation was 1 day (0-29). Mortality rate at 30-day was 9.5%. The median length of stay in ICU and hospital was 3(1-135) and 12(1-135) days, respectively. The length of time a patient waited after admission to hospital prior to the operation and LOS in ICU and hospital were found to have signifi cantly adverse effects on survival. The re-amputated patients were the ones who had signifi cantly longer preoperative waiting times and more postoperative complications. Conclusion:We herein documented the data of patients undergoing major limb amputation including preoperative care and perioperative complications. We tried to draw attention to the appropriate perioperative preparation of these patients and its effects on the outcomes.We believe the choice of anesthetic technique is not much more important than the preparation and consultation of the patient. Further studies might explain the importance of multidisciplinary, therapeutic approaches in altering the mortality and morbidity rates in these high-risk patient population.
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