Thirty Days vs One-Year Complications and Reoperations after Foot Amputation and Below Knee Amputation: A Large Database Study

Abstract

Category: Diabetes; Midfoot/Forefoot Introduction/Purpose: Below knee amputation (BKA) and Foot amputation (AA) are two commonly performed procedures for diabetic foot conditions. Aim of this study was to analyze the characteristics of the complications and reoperations at 30 days and 1 year in a matched sample of BKA and FA in diabetic patients in a large database population. Methods: Commercially available patient database record (PearlDiver) was used for this study. Diabetic Patient undergoing BKA and FA were identified using CPT code. After matching two groups for smoking, obesity and comorbidities scores, the differences in the risk of complications at 30 days, 90 days and 1 year and the risk of reoperation at 1 year were noted in both groups. Results: There were 8555 patients in each matched group. Most patients were male (71.6%) and 6891 patients were smokers and 5292 patients were obese. More than 50% of general and systemic complications happened after 30 days. Incidence of 30 days, 90 days and 1 year general complications including Acute kidney injury, cardiac arrest, Cerebrovascular event, myocardial infarction, Pulmonary embolism, Pneumonia, sepsis and transfusion were higher in the BKA group. AKI was the most common general complication and PE was the least common general complication observed at 30 days, 90 days and 1 year. The risk of wound dehiscence, surgical site infection and overall wound complications were higher in FA group. One year reoperation for infection and dehiscence were higher in the FA group and reoperation for hematoma formation was higher in BKA group. The risk of revision to a BKA in the FA group at 1 year was 16.4% (1410 patients). Conclusion: FA is associated with higher risk of local complications at 30 days, 90 days and 1 years and higher reoperation rate at 1 year for local complications. However, BKA is associated with higher systemic major complications and higher risk of reoperation for hematoma formation. Most complications in the FA and BKA group happened after 30 days which highlights the fact that studies reporting 30 days complications after FA and BKA may underestimate the complications.