A five years retrospective study of factors influencing outcome of major lower limb amputations


  • Sudhir Marahanumaiah Department of General Surgery, Kempegowda Institute of Medical Sciences Hospital, Bangalore, Karnataka, India
  • Sridhar Govindaiah Department of General Surgery, Kempegowda Institute of Medical Sciences Hospital, Bangalore, Karnataka, India




Major lower limb amputation, Peripheral vascular disease, Necrotizing fasciitis


Background: The word amputation is derived from Latin -Amputare - to cut away. The amputation is indicated when the limb is considered as dead limb/ deadly limb/ dead loss limb. Often cases are referred to tertiary centre late, resulting in complications which requires surgical management. Aim of the study was to compare the outcomes of major lower limb amputations and to identify risk factors associated with mortality and morbidity following major lower limb amputations.

Methods: A retrospective observational study was done for 5 years between January 2014 to November 2019, comprising 276 patients undergoing major lower extremity amputations. Adult patients undergoing lower extremity amputations for ischemic, infected or gangrenous lower limb were included and patients who underwent amputations for trauma or tumours were excluded. The data regarding comorbidities, postoperative complications, outcome of major lower limb amputations were evaluated.

Results: 276 patients underwent lower limb amputations (above knee amputations (AKA)-127, below knee amputations (BKA)-134, forefoot amputations-15). Male patients outnumbered females (6.7:1) and most of them were of elderly age group (mean age 60.56 years). The most common indications for amputations in our study were peripheral vascular disease (120), diabetes (87), necrotizing fasciitis (37). The 1 year mortality rates following lower limb amputations in our study were 14% (BKA) and 34% (AKA).

Conclusions: Lower limb amputations are associated with high mortality rates. Mortality can be expected in both the early and the late postoperative periods and is most probably related to serious comorbidities, such as renal and heart disease, rather than the level of amputation.

Author Biographies

Sudhir Marahanumaiah, Department of General Surgery, Kempegowda Institute of Medical Sciences Hospital, Bangalore, Karnataka, India


Sridhar Govindaiah, Department of General Surgery, Kempegowda Institute of Medical Sciences Hospital, Bangalore, Karnataka, India



Amputation, Arterial disorders, Bailey and love’s short practice of surgery 27th edition, CRC Press; 2018: 957.

Belmont PJ Jr, Davey S, Orr JD, Ochoa LM, Bader JO, Schoenfeld AJ. Risk factors for 30-day postoperative complications and mortality after below knee amputation: a study of 2,911 patients from the national surgical quality improvement program. J Am Coll Surg. 2011;213:370-8.

Nelson MT, Greenblatt DY, Soma G, Rajimanickam V, Greenberg CC, Kent KC. Preoperative factors predict mortality after major lower-extremity amputation. Surgery. 2012;152(4):685-94.

Hasanadka R, McLafferty RB, Moore CJ, Hood DB, Ramsey DE, Hodgson KJ. Predictors of wound complications following major amputation for critical limb ischemia. J Vasc Surg. 2011;54(5):1374-82.

Aulivola B, Hile CN, Hamdan A, Sheahan MG, Veraldi JR, Skillman JJ, et al. Major lower extremity amputation: outcome of a modern series. Arch Surg. 2004;139:395-9.

Feinglass J, Pearce WH, Martin GJ, Gibbs J, Cowper D, Sorensen M, et al. Postoperative and late survival outcomes after major amputation: findings from the Department of Veterans Affairs national surgical quality improvement program. Surgery. 2001;130:21-9.

Rosen N, Gigi R, Haim A, Salai M, Chechik O. Mortality and Reoperations following Lower Limb Amputations. IMAJ. 2014;16:83-7.

Eskelinen E, Lepantalo M, Hietala EM, Lukinmaa A, Brasken P, Railo M. Lower limb amputations in Southern Finland in 2000 and trends up to 2001. Eur J Vasc Endovasc Surg. 2004;27(2):193-200.

Lindholt JS, Bovling S, Fasting H, Henneberg EW. Vascular surgery reduces the frequency of lower limb major amputations. Eur J Vasc Surg. 1994;8(1):31-5.

Abou-Zamzam AM Jr, Teruya TH, Killeen JD, Ballard JL. Major lower extremity amputation in an academic vascular center. Ann Vasc Surg. 2003;17(1):86-90.

Cruz CP, Eidt JF, Capps C, Kirtley L, Moursi MM. Major lower extremity amputations at a Veterans Affairs hospital. Am J Surg. 2003;186(5):449-54.

The West coast Vascular Surgeons (WVS) Study Group. Variations of rates of vascular surgical procedures for chronic critical limb ischaemia and lower limb amputation rates in western Swedish counties. Eur J Vasc Endovasc Surg. 1997;14(4):310-14.

Mihalko MJ, Martinez SF. Amputations of the lower extremity, Campbell's operative orthopedics 12th edition. 2008: 637.

Lee TH, Marcantonio ER, Mangione CM. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043-9.

Impact of diabetes, lower extremity amputations, chapter 111, Rutherford’s Vascular surgery and endovascular therapy, 9th edition, page 4913.

Li Y, Burrows NR, Gregg EW, Albright A, Geiss LS. Declining rates of hospitalization for nontraumatic lower extremity amputation in the diabetic population aged 40 years or older: U.S., 1988-2008. Diabetes Care. 2012;35:273.

Lim TS, Angel D. Outcomes of a contemporary amputation series. ANZ J Surg. 2006;76:300-5.






Original Research Articles