Evaluation of Risk Factors for Progression of Proximal Limb Loss After Transmetatarsal Amputation

Risk factors for nontraumatic amputations are well-documented in literature. However, the risk of progression from transmetatarsal amputation (TMA) to more proximal is not well understood despite subsequent loss functionality. In this study, we investigated that were associated with limb among patients peripheral arterial disease (PAD). We analyzed our institutional database a single tertiary center January 2017 November 2022 on who underwent TMA amputations. Patients categorized into TMA-only and TMA-plus. TMA-plus indicates followed by (either below-knee or above-knee amputation) ipsilateral within 2-year period. excluded had contralateral limb. Logistic regression was performed between two cohorts including demographics, comorbidities, presentation, history revascularization, clinical outcomes. There 233 total TMAs, 51.9% (n = 121) 48.1% 112). no significant difference age, gender, body mass index, American Society Anesthesiologists classification. likely be Hispanic (28% vs 15%; P < .001), non-English-speaking (26% 13%; .02), have dependent functional status at baseline (46% .001). hypertension, chronic kidney disease, dialysis experience (Table) (P .01). Although preoperative sepsis significantly correlated > .05), active gangrene .02). Rutherford-classification 6 (major tissue loss), prior toe amputation, revision predictors progressive while previous revascularization .05). 30-day readmissions in-hospital mortality overall longer length stay (17 10 days; higher discharge rates skilled facilities (72% 36%; (29% 17%; .025). after times odds over those receive (odds ratio, 2.05; 95% confidence interval, 1.10-3.90; .026). PAD burden amputation. Identifying subset important as accelerated factor mortality.TableClinical (TMA)CharacteristicORa95% CIP valueRutherford Classification CLI - major loss5.693.00-10.83<.001Previous toe-amputation4.82.70-8.79<.001Preoperative infectious state SIRS1.090.59-2.00.8 Sepsis1.220.59-2.51.6 Severe sepsis2.130.60,8.55.3 Septic shock2.430.45-18.1.3Active gangrene2.021.13-3.67.018Revision required3.632.03-6.67<.001Previous revascularization1.410.83-2.40.2Hypertension10.23.44-43.6<.001Chronic disease2.091.24-3.57.006Risk mortalityORa95% value plus2.051.10-3.90.026CI, Confidence interval; CLI, critical ischemia; OR, ratio; SIRS, systemic inflammatory response syndrome.aUnivariate analysis Open table new tab