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Outcomes after Major Amputation in Octogenarians
Kyle Bui
*1, Anish Patel
1, Andrea Alonso
2, Elina Farber
1, Khuaten Maaneb de Macedo
2, Alik Farber
3, Jeffrey Kalish
3, Jeffrey J. Siracuse
31School of Medicine, Boston University, Boston, MA; 2General Surgery, Boston Medical Center, Boston, MA; 3Vascular and Endovascular Surgery, Boston Medical Center, Boston, MA
Background Major amputation can be morbid and significantly life changing. Older patients in particular may be susceptible to poor outcomes. Our goal was to assess short and long-term outcomes of major amputation in octogenarians.
Study Design A retrospective single-center chart review was performed on octogenarian patients who underwent a major amputation, defined as an amputation above the ankle, at a safety net hospital between the years 2014-2023. Patient demographics, operative characteristics, post-operative outcomes, and 30-day and 1-year outcomes were collected and analyzed.
Results There were 57 patients who were octogenarians who underwent a major amputation. Mean age was 84.8 years, and 57.9% were male gender. There were 64.9% Black, 15.8% White, and 19.3% other race patients. Common comorbidities included hypertension (94.7%), diabetes mellitus (68.4%), and coronary artery disease (56.1%). Patients had prior lower extremity (LE) bypass in 19.3%, prior LE endovascular in 31.6%, and prior contralateral LE amputation procedures in 8.8%. Preoperatively, 56.1% of patients were living at home. The majority of patients (96.5%) underwent an amputation for chronic limb threatening ischemia (CLTI) with 3.5% for acute limb ischemia. Indications for CLTI presentation was 54.2% gangrene/infection, 32.2% tissue loss/ulcer, and 10.2% rest pain. There were 28.1% of patients who presented with sepsis preoperatively. During the index encounter prior to amputation, 3.5% of patients underwent endovascularization, 1.8% of patients underwent bypass procedures, and 1.8% of patients underwent embolectomy. There were 68.4% above the knee amputations, 22.8% below the knee amputations, and 8.8% guillotine amputations. Intensive care unit (ICU) admission postoperatively was required in 33.3%. Total mean hospital length of stay was 13.5 days. Postoperatively, 56.1% were discharged to a skilled nursing facility, 17.5% patients to an acute rehab facility, and 12.3% to home with assistance. Thirty-day emergency department presentation was 15.8%, and hospital readmission was 14%. Most patients (84.2%) were non-ambulatory at 1-year. The in-hospital mortality was 8.8%, 30-day mortality was 14%, and 1-year mortality was 36.8%.
Conclusions Major amputations in octogenarians are morbid with high utilization of ICU, prolonged lengths of stay, and usually require discharge to long-term care facilities. Over one third are not alive at one year. Early revascularization, control of infection and improved goals of care discussions are opportunities for improvement in this patient population.
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