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Postoperative Mortality after Nontraumatic Lower Extremity Amputation in Patients with Renal Insufficiency

Ann M. O’Hare^*,, Joe Feinglass, Gayle E. Reiber^,||, Rudolph A. Rodriguez^*,,¶, Jennifer Daley^**,, Shukri Khuri^,, William G. Henderson^|||| and Kirsten L. Johansen^*,,¶¶

*Department of Medicine, San Francisco VAMC, San Francisco, California; Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California; Division of General Internal Medicine, Northwestern University Medical School, Chicago, Illinois; Departments of Health Services and Epidemiology, University of Washington, Seattle, Washington; ^||VA Puget Sound Health Care System, Seattle, Washington; ^¶Department of Medicine, San Francisco General Hospital, San Francisco, California; **Medical Affairs, Tenet Health System, Dallas, Texas; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts; Surgical Services, VA Boston Healthcare System, Boston, Massachusetts; ^||||University of Colorado Health Outcomes Program, Denver, Colorado; ^¶¶Departments of Epidemiology and Biostatistics, UCSF, San Francisco, California.

Correspondence to Dr. Ann M. O’Hare, Staff Physician, VA Medical Center, San Francisco, Box 111J, Nephrology Division, 4150 Clement Street, San Francisco, CA 94121. Phone: 415-221-4810 ext. 4953; Fax: 415-476-3381; E-mail: ann.o'hare{at}med.va.gov

ABSTRACT. Mortality rates after lower extremity amputation are extremely high among dialysis patients. However, the impact of milder degrees of renal insufficiency on death rates after lower extremity amputation has not been carefully examined. In this study, the authors used data from the Department of Veterans Affairs’ National Surgical Quality Improvement Program (NSQIP) to measure the association between renal dysfunction and 30-d mortality after nontraumatic amputation adjusted for confounders. The study population consisted of 16,994 patients undergoing their first NSQIP recorded amputation from January 1, 1994 through September 30, 2001. Thirty-five percent of all cohort patients had at least moderate renal insufficiency, and 52% of all postoperative deaths occurred in this group. Postoperative mortality was 9% in patients with moderate renal insufficiency, 15% in patients with severe renal insufficiency, and 16% in dialysis patients, compared with 6% in patients with normal or mildly reduced renal function. Renal insufficiency remained associated with death after adjustment for confounders (adjusted odds ratio [OR] 3.36, 95% confidence interval [CI] 2.75 to 4.10 [dialysis patients]; OR 2.54, CI 2.06 to 3.14 [severe renal insufficiency]; and OR 1.52, CI 1.32 to 1.76 [moderate renal insufficiency]). In conclusion, even moderate renal insufficiency is independently associated with postoperative death after lower extremity amputation. This finding highlights the need for a targeted approach to improving the care of patients with renal insufficiency undergoing lower extremity amputation.

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				A. M. O'Hare, E. Vittinghoff, J. Hsia, and M. G. Shlipak Renal Insufficiency and the Risk of Lower Extremity Peripheral Arterial Disease: Results from the Heart and Estrogen/Progestin Replacement Study (HERS) J. Am. Soc. Nephrol., April 1, 2004; 15(4): 1046 - 1051. [Abstract] [Full Text] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673