Trauma-Related Amputation Associated With Complications, Reoperation Risk

Trauma-related amputations carry a high risk of complications and additional surgeries, according to research.

Saam Morshed, M.D., MPH, conducted a study to explore the epidemiology of upper extremity amputation using secondary data analysis from the 2009-2012 National Trauma databank. Morshed is an orthopedic trauma surgeon and director of the Clinical Research Center at the University of California-San Francisco/San Francisco General Hospital Orthopaedic Trauma Institute. His clinical practice is focused on skeletal trauma, surgery of the pelvis and acetabulum, and problem fractures including mal-unions and non-unions.

The study data included 1,386 patients from 900 trauma centers around the United States, who underwent major upper extremity amputation following trauma. Researchers used multivariate regression models to identify predictors of adverse surgical complications, rate of reoperation and length of hospitalization.

Overall, 18 percent of the patients studied had surgical complications post-amputation and nearly 30 percent of patients underwent reoperation. Compartment syndrome and neurovascular disease were the major factors for reoperation. Pneumonia was also a major factor, as 5.52 percent of patients had pneumonia-related complications. About 3 percent of patients experienced complications due to acute kidney injury and 2.86 percent of patients had acute lung injury or respiratory distress syndrome-related complications.

Thrombophlebitis, severe sepsis, infection and ulceration were among the other predictors of surgical complications, as well as osteomyelitis, pulmonary embolism, graft, prosthesis and flap failure.

“Extremity trauma is becoming increasingly frequent and important,” Morshed said. “Given our most recent decade of war, more than half of wounded services members evacuated from the Middle East have extremity injuries.”