Martin C Berli1, Zoran Rancic2, Madlaina Schöni1, Tobias Götschi3, Pascal Schenk1, Method Kabelitz1, Thomas Böni1, Felix W A Waibel4. 1. Division of "Prosthetics and Orthotics", Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zürich, Switzerland. 2. Clinic for Vascular Surgery, University Hospital Zurich, and Medical Faculty, University of Zurich, Zurich, Switzerland. 3. Department of Orthopaedic Surgery, University of Zurich, Institute for Biomechanics, ETH Zurich, Balgrist Campus, Zurich, Switzerland. 4. Division of "Prosthetics and Orthotics", Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zürich, Switzerland. felix.waibel@balgrist.ch.
Abstract
INTRODUCTION: Repetitive minor amputations carry the concomitant risks of multiple surgical procedures, major amputations have physical and economical major drawbacks. The aim of this study was to evaluate whether there is a distinct number of minor amputations predicting a major amputation in the same leg and to determine risk factors for major amputation in multiple minor amputations. MATERIALS AND METHODS: A retrospective chart review including 429 patients with 534 index minor amputations between 07/1984 and 06/2019 was conducted. Patient demographics and clinical data including number and level of re-amputations were extracted from medical records and statistically analyzed. RESULTS: 290 legs (54.3%) had one or multiple re-amputations after index minor amputation. 89 (16.7%) legs needed major amputation during follow up. Major amputation was performed at a mean of 32.5 (range 0 - 275.2) months after index minor amputation. No particular re-amputation demonstrated statistically significant elevated odds ratio (a.) to be a major amputation compared to the preceding amputation and (b.) to lead to a major amputation at any point during follow up. Stepwise multivariate Cox regression analysis revealed minor re-amputation within 90 days (HR 3.8, 95% CI 2.0-7.3, p <0.001) as the only risk factor for major amputation if at least one re-amputation had to be performed. CONCLUSIONS: There is no distinct number of prior minor amputations in one leg that would justify a major amputation on its own. If a re-amputation has to be done, the timepoint needs to be considered as re-amputations within 90 days carry a fourfold risk for major amputation. LEVEL OF EVIDENCE: Retrospective comparative study (Level III).
INTRODUCTION: Repetitive minor amputations carry the concomitant risks of multiple surgical procedures, major amputations have physical and economical major drawbacks. The aim of this study was to evaluate whether there is a distinct number of minor amputations predicting a major amputation in the same leg and to determine risk factors for major amputation in multiple minor amputations. MATERIALS AND METHODS: A retrospective chart review including 429 patients with 534 index minor amputations between 07/1984 and 06/2019 was conducted. Patient demographics and clinical data including number and level of re-amputations were extracted from medical records and statistically analyzed. RESULTS: 290 legs (54.3%) had one or multiple re-amputations after index minor amputation. 89 (16.7%) legs needed major amputation during follow up. Major amputation was performed at a mean of 32.5 (range 0 - 275.2) months after index minor amputation. No particular re-amputation demonstrated statistically significant elevated odds ratio (a.) to be a major amputation compared to the preceding amputation and (b.) to lead to a major amputation at any point during follow up. Stepwise multivariate Cox regression analysis revealed minor re-amputation within 90 days (HR 3.8, 95% CI 2.0-7.3, p <0.001) as the only risk factor for major amputation if at least one re-amputation had to be performed. CONCLUSIONS: There is no distinct number of prior minor amputations in one leg that would justify a major amputation on its own. If a re-amputation has to be done, the timepoint needs to be considered as re-amputations within 90 days carry a fourfold risk for major amputation. LEVEL OF EVIDENCE: Retrospective comparative study (Level III).
Authors: P W Moxey; P Gogalniceanu; R J Hinchliffe; I M Loftus; K J Jones; M M Thompson; P J Holt Journal: Diabet Med Date: 2011-10 Impact factor: 4.359
Authors: Leena Remes; Raimo Isoaho; Tero Vahlberg; Heikki Hiekkanen; Kimmo Korhonen; Matti Viitanen; Päivi Rautava Journal: Aging Clin Exp Res Date: 2008-10 Impact factor: 3.636
Authors: Thomas V Häller; Peter Kaiser; Dominik Kaiser; Martin C Berli; Ilker Uçkay; Felix W A Waibel Journal: J Foot Ankle Surg Date: 2020 Jan - Feb Impact factor: 1.286
Authors: Peter Kaiser; Thomas Vincent Häller; Ilker Uçkay; Dominik Kaiser; Martin Berli; Thomas Böni; Felix Waibel Journal: J Foot Ankle Surg Date: 2019-11 Impact factor: 1.286
Authors: Felix W A Waibel; Alexander Klammer; Tobias Götschi; Ilker Uçkay; Thomas Böni; Martin C Berli Journal: Foot Ankle Int Date: 2019-01-28 Impact factor: 2.827