OUTCOME FOLLOWING BELOW-KNEE AMPUTATION FOR LIMB ISCHEMIA - A MULTIVARIATE ODDS RATIO ANALYSIS OF CLINICAL-VARIABLES

One hundred and eleven consecutive patients undergoing below-knee ampu tation for end-stage limb ischemia were reviewed. Decision on the leve l of amputation was made mainly on clinical grounds. Univariate and mu ltivariate analyses of the outcomes, including revision to above-knee amputation and ability to walk, were carried out for seven preoperativ e clinical variables related to history alone. Median age was seventy- one years old and there were 74 men. Fifty percent of the patients wer e diabetic, 14% had neurologic dysfunction, 17% had undergone remote r evascularization, 25% had undergone contralateral lower extremity ampu tation, and 23% underwent unsuccessful attempt at foot salvage prior t o amputation. Operative mortality was 10% and morbidity excluding woun d complications was 14.5%. Wound complications not requiring further s urgery occurred in 10 patients who all eventually walked with a prosth esis. Incidence of revision to above-knee amputation was 19%. Diabetic s had less occurrence of this event (odds ratio 0.3, p=0.011). Twenty- five patients were lost at one-year follow-up. Sixty-two % of patients were alive at greater than one year postoperatively and 49% were able to walk with a prosthesis. Potential for rehabilitation among patient s with below-knee amputation was adversely affected by preoperative ne urologic dysfunction (odds ratio 11.8, p=0.003) and favored by remote lower extremity revascularization (odds ratio 0.3, p=0.04). In patient s who required revision to above-knee amputations (n=21), only 38% wer e able to walk with a prosthesis as compared with 51% for those who di d not require stump revisions (p=0.065). Interestingly, there was no e ffect of age detected on either survival or rehabilitation to walk. Ab ility to identify high-risk patients will facilitate their selection f or primary above-knee amputations.