16.17 Decisions in Crisis: The Impact of Timing on Amputation Outcomes for Severe Lower Limb Injuries

Posted on May 12, 2025

R. Vetri1, A. Rafieezadeh2, A. Jose2, K. Prabhakaran2, J. Kirsch2, I. Shnaydman2, J. Klein2, G. Froula2, M. Bronstein2, B. Zangbar2  1Westchester Medical Center, Surgery, Valhalla, NY, USA 2New York Medical College, Valhalla, NY, USA

Introduction:
Limb amputation is a difficult choice. Late amputations could be associated with complications. In this study, we compared the outcomes of patients undergoing early versus late amputation for severe lower limb injuries.

Methods:
We conducted a retrospective review of Trauma Quality Improvement Program (2017-2021) and included all ages with isolated blunt severe lower limb injury (AIS ≥ 3) that underwent limb amputation. Patients were stratified based on time to amputation into early (≤48 hours) and late (>48 hours). Primary outcome of this study was mortality. Secondary outcomes were in-hospital complications, hospital and ICU length of stay (LOS) and discharge disposition. We performed a Propensity Score Matching to match the two groups and compared the outcomes.

Results:
Data of 4,439 patients was assessed. The mean time to amputation was 6.33±8.13 days. Among these patients, 1,959 cases (44.1%) had early amputation (mean procedure time of 1.25±0.43 days) and 2,480 cases (55.9%) had late amputations (mean procedure time of 10.34± 9.05 days). After matching, data of 3,526 patients (1,763 cases in each group) was evaluated. No difference was found between the two groups regarding mortality (p=0.06). Patients in the early amputation group, compared to late group, had significantly lower rates of acute kidney injury (2% vs. 4.6%), osteomyelitis (0.6% vs. 1.3%), unplanned intubation (1.2% vs. 2.4%), unplanned ICU admission (3% vs. 5.6%), unplanned return to operation room (2.6% vs. 8.5%) and higher rates of home discharge (39.6% vs. 27.9%) (p<0.05). The hospital and ICU LOS were significantly lower in early amputation group compared to late group (p<0.001). 

Conclusion:
Early amputation in patients with serious lower limb injuries is associated with fewer complications, shorter hospital and ICU stays, and a higher rate of home discharge compared to late amputation.