Mortality Associated With Upper Extremity Amputations in Vasculopathic Patients: A Matched Cohort Analysis of 9,904 Individuals.

Abstract

Purpose: Peripheral vascular disease (PVD) is a well-established risk factor for lower-extremity amputations and is associated with poor outcomes and increased mortality for patients undergoing these procedures. However, the outcomes and mortality risks for vasculopathic patients undergoing upper-extremity amputations (UEA), particularly of the hand, are less understood. This study aimed to elucidate the mortality risks associated with UEA in patients with PVD.

Methods: The TriNetX database was retrospectively queried using International Classification of Diseases-10th Clinical Modification and Current Procedural Terminology coding to identify patients with and without PVD who underwent UEA procedures. Patients were split into the following two cohorts: (1) UEA without PVD (no PVD), and (2) UEA with PVD (PVD). Cohorts were matched 1:1 using propensity scoring based on age, sex, body mass index, diabetes, and tobacco use. Relative risks, hazard ratios of mortality, and Kaplan-Meier survival analyses were performed to determine mortality rates at 6 months, 1 year, 5 years, and 10 years after initial UEA.

Results: This study identified 36,368 patients, with 6,750 patients in the UEA with PVD cohort, and 29,213 patients in the UEA with no PVD cohort. Each matched cohort consisted of 4,952 patients. Patients without a history of PVD undergoing UEA were considerably less likely to die at each time point. Furthermore, the risk of mortality was lower for the no PVD cohort, and mortality rates were higher for the PVD group at each time point.

Conclusions: These findings showed increased mortality risk for UEA patients with PVD compared with patients without PVD.

Type of study/level of evidence: Prognosis II.