Coronary Artery Disease as a Predictor of Reduced Independent Ambulation After Major Lower Extremity Amputation

Abstract

Background

Major lower extremity amputation (MLEA) is a common surgery that poses major morbidity and mortality concerns in older patients. Coronary artery disease (CAD) may play a role in patient recovery after major amputation due its impact on functional status. We aim to elucidate the relationship between history of CAD and independent ambulation after MLEA to help guide surgical intervention in high-risk patients.

Materials and Methods

This was a retrospective study of 689 patients who underwent major lower extremity amputation from 2014-2022 at a major tertiary referral center. Statistical tests included Chi-square, T-test, univariable and multivariable logistic regression.

Results

Our study included a total of 689 patients. Twenty-eight percent (n = 190) of patients who underwent MLEA had CAD. The median age of the CAD cohort was 64 years and that of the non-CAD cohort was 56 years. The racial composition across both cohorts was 47.6% African American, 46.9% Caucasian, and 5.5% Other. Comorbidities included diabetes (52.4%), hypertension (67.9%), hyperlipidemia (40%), and peripheral vascular disease (45.3%). Both cohorts had similar pre-operative functional status (P = .058). However, postoperatively, patients with CAD had lower rates of independent ambulation (P = .004). CAD had no association with total hospital length of stay (P = .888). CAD negatively affected postoperative ambulation and was associated with increased 1-year mortality.

Conclusion

CAD is a predictor of reduced ambulation and 1-year mortality after MLEA, highlighting the need to promote early independent ambulation in this population after major amputation.