The impact of previous surgery and revisions on outcome after major lower limb amputation.

Introduction: Morbidity and mortality after lower limb amputation (LLA) remain disappointingly high. This study aimed to assess the impact of previous ipsilateral vascular intervention on outcomes after major LLA.

Methods: Prospective data were collected for all major LLAs performed between January 2010 and December 2011. Those who underwent a primary amputation were compared with secondary amputees to establish if previous interventions were a risk factor for morbidity and mortality.

Results: One hundred forty-eight patients underwent LLA during the study period; 102 were primary amputees, and 46 (31.1%) had undergone previous ipsilateral revascularization. The groups were well matched for demographics and comorbidities. Those who underwent secondary amputations were older (P=0.016) and more likely to suffer from hypercholesterolemia (P<0.001). Patients who had undergone a previous intervention were more likely to need revision surgery (17% vs. 4.5% P=0.027). Previous intervention was not found to be a risk factor for more proximal amputation level (P=0.341) or increased postoperative mortality (P=0.782), however.

Conclusions: Patients who have undergone previous revascularization may be at higher risk of revision surgery. Survival after major LLA does not appear to be associated with previous revascularization attempts.