Purpose
Digital amputation is a commonly performed procedure for infection and necrosis in
patients with diabetes, peripheral vascular disease (PVD), and on dialysis. There
is a lack of data regarding prognosis for revision amputation and mortality following
digital amputation in these patients.
Methods
All digital amputations over 10-year period (2008–2018) at a single center were reviewed.
There were 484 amputations in 360 patients, among which 358 were performed for trauma
(reference sample) and 126 for infection or necrosis (sample of interest). Patient
death and revision were determined from National Vital Statistics System and medical
records. Propensity score matching was performed to compare groups. Data were then
compared to the Social Security Administration Actuarial Life Table for 2015 to determine
age-matched expected mortality.
Results
The 2-year revision rate was 34% for amputations performed for infection or necrosis,
compared to 15% for amputations due to trauma. For amputations performed for infection
or necrosis, the revision rate was 47.7% when diabetes, PVD, and dialysis were present.
Among all patients with infection or necrosis (n = 104) undergoing a digital amputation,
overall survival at 2, 5, and 10 years was 79.4%, 57.3%, and 17.5%, respectively,
which represented a 3.2-fold increased risk of death compared to controls. (hazard
ratio, 3.19; 95% confidence interval, 1.47–6.93). For amputations due to trauma, mortality
was no different from that in the age-matched general population.
Conclusions
Mortality and revision risk are high for patients requiring a digital amputation for
infection or necrosis and are further increased with medical comorbidities. Hand surgeons
should consider the prognostic implications of these data when counseling patients.
Type of study/level of evidence
Prognostic IV.
Key words
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Article info
Publication history
Published online: March 15, 2023
Accepted:
January 13,
2023
Received:
December 28,
2020
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2023 by the American Society for Surgery of the Hand. All rights reserved.
