Excellent work recently from Jupiter and coworkers provides insightful observations on early postoperative complications for transmetatarsal and minor amputations versus major amputations.1
We understand that more proximal amputations compromise function but it is important to grasp other aspects of the differences between these and more distal amputations. These researchers took data from the National Surgical Quality Improvement Program from 2012 to 2014 and studied multiple metrics.1 Jupiter and colleagues found that patients who had major amputation were more likely to have a dependent functional status. Patients who had minor amputations were more likely to have further irrigation and debridement procedures (2.5 times higher) than those with major amputations. The researchers showed that short-term complications, readmission and reoperation were more prevalent in those with more distal amputations. Urinary tract infections and the need for transfusion were more common among those who had major amputations.
It is possible that the need for readmission and reoperation could be due to the nature of staging procedures (such as multiple debridements, grafting, use of negative pressure wound therapy, etc.) necessary in order to achieve a more distal limb salvage.
In regard to the unique complications more attributable to those who had a major amputation, these patients are more likely to be dependent as opposed to independent, have less movement postoperatively and their procedures inherently lend themselves more to these specific complications. For instance, major amputations can be longer procedures, necessitating insertion of an intraoperative catheter. Blood loss is also likely to be larger in those with major amputation, increasing the likelihood of the need for transfusion.
As this study looked at short-term complications, an interesting next step would be to compare the rates of various longer-term complications to help assess the most optimal level of amputation in a given patient case.
Dr. Armstrong is a Professor of Surgery at the Keck School of Medicine at the University of Southern California. He is the Director of the Southwestern Academic Limb Salvage Alliance (SALSA).
Editor’s Note: This blog originally appeared at:
https://diabeticfootonline.com/2020/05/10/transmetatarsal-and-minor-amputation-versus-major-leg-amputation-30-day-readmissions-reamputations-and-complications-actagainstamputation-diabeticfoot/. It is adapted with permission from the author.
- Jupiter DC, Beaino ME, LaFontaine J, Barshes N, Wukich DK, Shibuya N. Transmetatarsal and minor amputation versus major leg amputation: 30-day readmissions, reamputations, and complications. J Foot Ankle Surg. 2020;59(3):484-490.