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Abstract
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Introduction:
Primary below knee amputations (BKA) are often the last option in surgical treatment for many medical conditions and are performed by different surgical subspecialities. Amputations are often times performed in order to save a patient’s life.
We therefor asked, (1) what is the survival rate of BKA amputees in Switzerland, (2) how do these rates differ between different surgical subspecialities, and (3) how did these rates change over time?
Methods:
Retrospective review of all patients undergoing a BKA at one of three hospitals of the same public hospital group consisting of two level 2 rural hospitals and one level 3 main hospital between January 2009 and December 2019 resulted in 98 BKA. Survival rates were calculate according to Kaplan-Meier and Cox regression analysis performed to identify risk factors.
Results:
Thirty-two patients died at a mean of 1.1 years (range 0-4.2 years) after BKA at a mean age of 74.3 years (50.9-98.9). The half year, 1-year, and 2-years survival rate of patients undergoing BKA is 82.0% (95% confidence interval [CI] 74.3-89.8%), 75.2% (95% CI 66.0-84.3%), and 71.9% (95% CI 62.1-81.7%) respectively.
The main reason for Burgess amputation was ischemia in 53%, diabetes in 19%, infection (w/o diabetes) in 15%, trauma in 9%, and other causes in 4%.
Burgess amputations were performed by vascular surgeons in 42%, by orthopaedic and trauma surgeons in 41%, and general and visceral surgeons in 17%.
Risk factors for death after BKA are secondary wound closure (hazard ratio [HR]= 7.996, p-value= 0.011), ASA score (HR= 5.409, p-value= 0.001), and high diastolic A. brachialis blood pressure (HR = 1.098, p-value= 0.041).
Conclusion:
Survival of patients undergoing BKA is low. There was no relevant change of survival rate over the course of the observation period. Several risk factors for death after BKA were identified.
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