Optimizing Lower Extremity Amputation Outcomes: The Impact of Multidisciplinary Consultations on Revision Rates in Non-Traumatic Lower Extremity Amputations

Background/Purpose: Amputation is not merely a limb-saving surgery; it can also impose a significant burden on the healthcare system due to psychological issues and the need for prolonged, recurrent hospitalizations. Revision surgeries following lower extremity amputations continue to occur at high rates. Our study aims to identify the factors leading to revision after non-traumatic lower extremity amputations and determine whether the level of the initial amputation was accurately determined by examining the correlation between these revisions and recommendations from multidisciplinary consultations (MDC). Methods: This retrospective study included diabetic foot patients undergoing below-knee amputations between 2016 and 2021. Two groups were formed: the revision group (35 patients transitioning from transtibial to transfemoral amputation) and the control group (35 patients with initial amputations). Gender, etiology, amputation levels, time to revision, follow-up, vascular status, and multidisciplinary consultations were analyzed. The MDC team for determining the amputation levels involved orthopedics, cardiovascular surgery, plastic surgery, and infectious diseases. Each patient's adherence to the MDC recommendation level was analyzed. Results: The average follow-up time was 4.84 years. Amputation level, revision/control group status, and variables such as year, age group, and gender were independent of each other. All amputations in the revision group (100%, n=35) were transtibial. In the control group, 20% (n=7) were at the transfemoral level and 80% (n=28) were at the transtibial level. MDC recommended transfemoral amputation (TFA) to 80% (n=28) and transtibial amputation (TTA) to 20% (n=7) of participants in the revision group. MDC recommended TFA to 20% (n=7) and TTA to 80% (n=28) of participants in the control group. Of the total sample, 60% (n=42) underwent surgery aligning with MDC guidelines, while 40% (n=28) underwent procedures deviating from the recommended level. All patients (n=28, 100%) not adhering to MDC recommendations underwent revision. Conversely, among those adhering to recommendations, 83.3% (n=35) did not require revision, while only 16.7% (n=7) required it, showcasing a significant decrease in revision need when adhering to MDC recommendations (p<0.0001). Conclusion: Non-compliance with MDC recommendations was strongly linked to the necessity for revisions, whereas adherence significantly decreased this need. Additionally, patients under 65, males, and those recommended transtibial amputations by MDC experienced longer revision-free intervals. These findings underscore the significance of following MDC-recommended levels, helping patients and their families make informed decisions regarding higher amputation levels as the initial surgery. Level of Evidence: Level 3 (a retrospective cohort study)