Does Specialty Matter? A Comparison of Early Postoperative Clinical Outcomes Following Lower Extremity Amputations Between Orthopaedic Surgeon and Vascular Surgeon
Authors: Shahsavarani Shaya , Sogard Oliver , Lee Wonyong 
Published: December 2024

Category:

Other

Introduction/Purpose:

Lower extremity amputations are performed by several specialties, with orthopaedic surgery (OS) and vascular surgery (VS) being the two most prevalent. Outcomes following lower extremity amputations, including complications, discharge destination, the rates of mortality, reoperation, and readmission, may vary between these specialties. This variation could be attributed to the underlying reasons for amputation (traumatic vs. vascular) and the urgency level of each case. Understanding the distinctions in outcomes of lower extremity amputations between these surgical specialties could enable surgeons to predict patient outcomes and set realistic patient expectations more accurately. To our knowledge, there is no research comparing postoperative outcomes of lower extremity amputations across these specialties. Our study aims to fill this gap by analyzing data from the National Surgical Quality Improvement Program (NSQIP).

Methods:

This study analyzed data from NSQIP spanning the years 2016 to 2018, focusing on patients who underwent primary lower extremity amputations. The NSQIP database was searched using Current Procedural Terminology (CPT) codes to identify these patients. The scope of primary amputations included not only below-knee amputations (BKAs) but also above-knee amputations (AKAs) and amputations involving the hindfoot, midfoot, and forefoot. The CPT codes employed for this comprehensive search were 27590, 27591, 27592, 27598, 27880, 27881, 27882, 27888, 27889, 28800, 28805, 28810, 28820, and 28825. The study compared differences in demographics, comorbidities, surgical procedures, and early 30-day postoperative outcomes between the OS and VS. Primary outcomes included mortality, readmission, reoperation, while secondary outcomes focused on complications such as sepsis, infection, wound disruption, DVT/PE, ventilator use greater than 48 hours, perioperative blood transfusion, pneumonia, unplanned reintubation, acute renal failure, urinary tract infection, cardiac arrest, myocardial infarction, and stroke.

Results:

16,475 cases were included in this study. 2,556 (15.6%) were conducted by OS while 10,077 (61.1%) by VS. 3,842 (23.3%) were conducted by other specialties, including general surgery and they are not included in our comparison. OS had more emergent cases than elective (16.6% Vs. 13.8%). Regarding the primary outcomes, surgeries by VS showed higher rates of mortality (6.5% Vs. 3.8%), reoperations (9.6% Vs. 7.5%), and readmissions (15.0% Vs. 12.3%). VS had longer length of stay (10.8 days Vs. 8.2 days) and more often tended to have a non-home disposition (81.2% Vs.51.8%). OS showed longer OR time (78.3 minutes Vs. 62.9 minutes). There was no significant difference in the rate of secondary outcomes between two groups, including infection, wound disruption, and DVT/PE.

Conclusion:

Equivalent outcomes following lower extremity amputations between OS and VS were observed in secondary outcomes, including infections and DVT/PE. However, OS had more emergency cases and longer OR time. VS had significantly higher rates of mortality, reoperation, and readmission in the early 30-day postoperative period, and a greater tendency for non-home dispositions. This indicates that patients requiring amputations under the care of VS may experience more complicated postoperative courses. Further analysis is necessary to better correlate diagnoses with these outcomes, which could enhance the prediction of patient outcomes, including potential complications, and help in setting more accurate realistic patient expectations.