Phair J, et al. - In this study, predictors of readmission after major lower extremity amputation (LEA) were determined. Findings revealed high 30-day readmission rate after major LEA. Wound infections accounted for a significant proportion of these re-admissions. No difference was evident in readmission rates based on level of amputation. Patients who underwent below-knee amputation (BKA) more frequently presented with stump complications requiring a surgical intervention, and often a higher level of amputation. Postoperative readmissions and stump complications could be reduced with the identification of high-risk patients.

Methods

• A retrospective review was performed of all patients undergoing above-knee amputation (AKA) or below-knee amputation (BKA) between November 2009 and November 2014.
• Researchers collected patient demographic variables.
• By multivariable logistic regression, predictors of unplanned 30-day readmission and stump complications were determined.

Results

• Researchers identified 811 patients (AKA, 325; BKA, 486).
• Out of these, they included 739 patients in the final analysis after excluding 30-day decedents without readmission.
• The overall 30-day readmission rate of 28.8% (AKA 27.9%; BKA 29.4%; P = .730) was observed.
• 28.6% of readmissions were related to stump complications (16.5% of AKA; 35.8% of BKA; P = .004).
• Nonsurgical site infection (33.8%), exacerbation of congestive heart failure (7.0%), and diabetes-related complications (6.1%) were other common diagnoses included.
• They performed surgical intervention on 61% of stump complications (35.9% of AKA readmitted with stump complications; 68.7% of BKA readmitted with stump complications).
• In 34.1% of cases, BKA stump complications were converted to AKAs (3.2% of the total BKA).
• A higher level of amputation was not required in any of the AKA stump complications (ie, hip disarticulation).
• In this study, coronary artery disease and end-stage renal disease were identified as the independent predictors of all 30-day readmission. They realized that American Society of Anesthesiologists class 3 as compared with class 4 was protective.
• For stump complications, independent predictors of 30-day readmission included rest pain and BKA.
• Predictors of having a stump complication requiring surgery were patients who underwent BKA, rest pain as an indication for amputation, and having an occluded bypass graft.