Background
The above-knee amputation (AKA) is an operation of last resort with high post-operative morbidity and mortality. This study identifies pre-operative risk factors predictive of both 30-day mortality and extended length of stay (LOS) in AKA patients.
Materials and Methods
Two hundred and ninety-five AKA patients from 2004-2013 from a single institution were retrospectively reviewed using a de-identified electronic medical record. Rationally selected factors potentially influencing 30-day mortality and LOS were chosen, including demographics, etiologies, vascular surgical history, lifestyle factors, comorbidities and laboratory values. Variables trending with one of the endpoints on bivariate analysis (P ≤ .10) were entered into multivariate forward stepwise regression models to determine independence as a risk factor (P ≤ .05). Subgroup analysis of AKA patients without a traumatic, burn or malignant etiology was similarly conducted.
Results
Within the 295 patient cohort, 60% of patients were male, 18% were African-American, mean age was 58 years old and mean body-mass index was 28 kg/m2. The 30-day mortality rate was 9%, and mean post-operative LOS of discharged patients was 9.3 days. Upon logistic regression, thrombocytopenia (platelet count < 250 ×106/mL; P < .001, odds ratio 6.1) and pre-operative septic shock (P = .02, odds ratio 5.1) were identified as independent risk factors for 30-day mortality. Upon linear regression, burn etiology (P < .001, B = 15.8 days), leukocytosis (white blood cell count < 12 ×106/mL; P < .001, B = 6.2 days) and guillotine amputation (P < .001, B = 7.6 days) were independently associated with prolonged LOS. Excluding patients with AKAs due to trauma, burn or malignancy, only thrombocytopenia (platelet count < 250 ×106/mL; P < .001, odds ratio 10.2) and leukocytosis (white blood cell count > 12 ×106/mL; P = .01, B = 5.2 days) were independent risk factors for in-hospital mortality and prolonged LOS, respectively.
Conclusions
Pre-operative septic shock and thrombocytopenia are independent risk factors for 30-day mortality after AKA, while burn etiology, leukocytosis and guillotine amputation contribute to prolonged LOS. Awareness of these risk factors may help enhance both pre-operative decision-making and expectations of the hospital admission.