Major lower extremity amputations are often performed as a last resort for
patients with severe comorbidities such as pronounced peripheral arterial
disease, dysregulated diabetes, and renal insufficiency. Despite advancements
in surgical techniques and perioperative care, outcomes for this patient group
remain challenging. This PhD thesis investigated epidemiological trends and
outcomes associated with major lower extremity amputations in Denmark
between 2010 and 2021, using data from national health registers.
Study I analyzed trends in amputation levels and found a significant increase in
transfemoral amputations performed in Denmark over time. These changes
were unrelated to patient comorbidities but reflected shifts in surgical practice.
The annual number of amputations remained stable at approximately 1,000
cases per year, but the adjusted incidence rate declined.
Study II examined the risk of re-amputation and identified critical risk factors,
including patient age, health status, and amputation level. Knee disaticulations
and transtibial amputations were associated with the highest re-amputation risk,
highlighting the importance of careful preoperative planning and decision on
amputation level.
Study III focused on mortality following major lower extremity amputations.
Although mortality rates improved slightly over the study period, they remained
high. For example, 30-day mortality for transfemoral amputations decreased
from 27% in 2010 to 22% in 2021. In adjusted analysis the mortality was
significantly higher after a transfemoral amputation compared to a transtibial
amputation.
Study IV evaluated the length of hospital stay and readmission rates. Although
average hospital stays had decreased, readmission rates remained persistently
high. The most frequent cause of readmission was stump complications. These
findings highlight the need for improved perioperative pathways to address
persistently high readmission rates despite shorter hospital stays.
Overall, this thesis provides new insights into major lower extremity amputations
in Denmark and the challenges in optimizing patient outcomes. The increasing
preference for transfemoral amputations, despite stable amputation rates,
raises questions about surgical decision-making and the balance between
minimizing re-amputation risk and preserving functional potential. While
transfemoral amputations reduce re-amputation rates and hospital stays, they
are associated with higher mortality and presumably poorer functional
outcomes. This highlight the need for decision-making tools that integrate
clinical evidence and patient-centered considerations to guide amputation level
selection.
The findings of the thesis lay the groundwork for future research and strategies
to improve care. A structured, multidisciplinary approach—potentially inspired
by orthogeriatric models—may help reduce mortality, re-amputation risk, length
of stay and readmission risk, while also enhancing rehabilitation outcomes for
this vulnerable patient group.
| 