Postoperative Mortality after Nontraumatic Lower Extremity Amputation in Patients with Renal Insufficiency

Ann M. O'Hare*, Joe Feinglass, Gayle E. Reiber, Rudolph A. Rodriguez, Jennifer Daley, Shukri Khuri, William G. Henderson, Kirsten L. Johansen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

56 Scopus citations


Mortality rates after lower extremity amputation are extremely high among dialysis patients. However, the impact of milder degrees of renal insufficiency on death rates after lower extremity amputation has not been carefully examined. In this study, the authors used data from the Department of Veterans Affairs' National Surgical Quality Improvement Program (NSQIP) to measure the association between renal dysfunction and 30-d mortality after nontraumatic amputation adjusted for confounders. The study population consisted of 16,994 patients undergoing their first NSQIP recorded amputation from January 1, 1994 through September 30, 2001. Thirty-five percent of all cohort patients had at least moderate renal insufficiency, and 52% of all postoperative deaths occurred in this group. Postoperative mortality was 9% in patients with moderate renal insufficiency, 15% in patients with severe renal insufficiency, and 16% in dialysis patients, compared with 6% in patients with normal or mildly reduced renal function. Renal insufficiency remained associated with death after adjustment for confounders (adjusted odds ratio [OR] 3.36, 95% confidence interval [CI] 2.75 to 4.10 [dialysis patients]; OR 2.54, CI 2.06 to 3.14 [severe renal insufficiency]; and OR 1.52, CI 1.32 to 1.76 [moderate renal insufficiency]). In conclusion, even moderate renal insufficiency is independently associated with postoperative death after lower extremity amputation. This finding highlights the need for a targeted approach to improving the care of patients with renal insufficiency undergoing lower extremity amputation.

Original languageEnglish (US)
Pages (from-to)427-434
Number of pages8
JournalJournal of the American Society of Nephrology
Issue number2
StatePublished - Feb 2004

ASJC Scopus subject areas

  • Nephrology


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