Evaluation of Clinical Outcomes Following Minor Amputations in Australia - An Important Consideration for Timing of Revascularisation

Impact of Timing of Minor Amputations After Revascularization on Patient Outcomes

BACKGROUND

Vascular complications from diabetes contribute significantly to major and minor limb amputations. Diabetes is a major health burden in Saudi Arabia, with increased incidence in rural areas. The purpose of this study was to evaluate the timing of minor lower limb amputations after revascularization and their relative outcomes.

METHODS

This was a retrospective study done in Prince Sultan Military Medical City, Riyadh, Saudi Arabia. Patients who underwent minor lower limb amputation after revascularization during 2018-2022 were included in the study.

RESULTS

Of the 90 patients who were eligible for the study, 83 (94%) were diabetic, and 66 (73%) underwent revascularization. The timing between revascularization and amputation varied, with 34 (37.8%) amputations occurring on the same day as revascularization, 17 (18.9%) occurring within seven days of revascularization, and 39 (43.3%) occurring more than seven days post-revascularization. No significant differences in amputation (p=0.105) were observed based on the timing of amputation after revascularization. Diabetic patients showed significantly higher rates of wound infection (p=0.028) and longer healing times (p=0.000). Finally, diabetic patients were more likely to have healing times of more than 60 days (25.9%) compared to non-diabetic patients (20.0%).

CONCLUSION

Based on our results, the timing of endovascular or surgical repair did not affect patient outcomes. Moreover, diabetes was found to be a prognostic factor for poor wound healing and infection.

Younger patients with chronic limb threatening ischemia face more frequent amputations

INTRODUCTION

Amputations among younger patients with chronic limb threatening ischemia (CLTI) may carry higher personal and societal costs, but younger patients are often not included in CLTI research because of dataset limitations. We aimed to characterize and compare outcomes between younger (<65 years old) and older patients with CLTI.

METHODS

This retrospective cohort study identified patients with CLTI between July 1, 2014 and December 31, 2017 in the MarketScan commercial claims database, a proprietary set of claims for over 50 million patients with private insurance in the United States. The primary outcome was major adverse limb events (MALE); secondary outcomes included amputations, major adverse cardiovascular events, and statin prescription fills.

RESULTS

The study cohort included 64,663 people with CLTI, of whom 25,595 (39.6%) were <65 years old. Younger patients were more likely to have diabetes mellitus (54.1% versus 49.9%, P<.001) but less likely to have other comorbidities. A higher proportion of younger patients suffered MALE (31.7% versus 30.2%, P=.002), specifically amputation (11.5% versus 9.3%, P<.001). After adjustment, age <65 years old was associated with a 24% increased risk of amputation (HR_adj 1.24, 95%CI 1.18-1.32, P<.001) and a 10% increased risk of MALE (HR_adj 1.10, 95%CI 1.07-1.14, P<.001).

CONCLUSIONS

A significant proportion of commercially insured patients with CLTI are under the age of 65, and younger patients have worse limb-related outcomes. These findings highlight the importance of aggressively treating risk factors for atherosclerosis and intentionally including younger patients with CLTI in future analyses to better understand their disease patterns and outcomes.