Improved long-term functional outcomes and mortality of patients with vascular-related amputations utilizing the lower extremity amputation pathway

BACKGROUND:Enhanced recovery after surgery (ERAS) pathways lead to improve perioperative outcomes for patients with vascular related amputations, however long-term data and functional outcomes are lacking. This study evaluated patients treated by the Lower Extremity Amputation Pathway (LEAP) and identified predictors of ambulation. METHODS:A retrospective review of LEAP patients who underwent major amputation from 2016 to 2022 for WIfI Stage V disease was performed. LEAP patients were matched 1:1 with retrospective controls (NOLEAP) by hospital, need for guillotine amputation, and final amputation type (above vs below knee). Primary endpoint was K-level (functional classification of patients with amputations) at last follow-up. RESULTS:126 patients with vascular related amputations (63 LEAP and 63 NOLEAP) were included. 71% were male and 49% were Hispanic with a mean state area deprivation index of 9/10. There were no differences in baseline demographics or co-morbidities. (Table 1) All patients had a K level >0 (ambulatory) prior to amputation and an average modified frailty index of 4. Median follow up was 270 days [IQR 84-1234] in the NOLEAP group and 369 days [IQR 145-481] in the LEAP group . Compared to NOLEAP, LEAP patients were more likely to receive a prosthesis (86% vs 44%,p>0.001). LEAP patients were more likely to have K level>0 (60% vs 25%,P=0.003). On multivariable logistic regression, participation in LEAP increased the odds of K level>0 at follow-up by 5.8 fold (OR 5.8, 95% CI 2.5,13.6). Patients with a K level >0 had significantly higher survival at 4 years (93% vs 59%, p=0.001). In a Cox-proportional hazards model, adjusted for demographics, co-morbidities and amputation level, a K level of >0 at follow-up was associated with an 88% reduction in the risk of mortality compared to K level=0. CONCLUSION:LEAP leads to improved ambulation with a prosthesis in a socioeconomically disadvantaged and frail patient population. Patients with a K level >0 (ambulatory) have significantly improved mortality.