Predictors of 30-day mortality in major lower limb amputations: insights from a five-year retrospective study in a South Asian LMIC
Abstract Background Major lower limb amputation (MLLA) is a life-saving procedure with significant morbidity and mortality. The objectives of this study were to determine the incidence of 30-day mortality, perioperative complications, and predictive risk factors of mortality in MLLA patients. Method...
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BMC
2025-07-01
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| Series: | BMC Surgery |
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| Online Access: | https://doi.org/10.1186/s12893-025-03013-5 |
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| author | Mohammad Zakriya Zia Ur Rehman Muhammad Anees Hafsa Shaikh Adnan Qadir Memon Nadeem Ahmed Siddiqui Fareed Shaikh |
| author_facet | Mohammad Zakriya Zia Ur Rehman Muhammad Anees Hafsa Shaikh Adnan Qadir Memon Nadeem Ahmed Siddiqui Fareed Shaikh |
| author_sort | Mohammad Zakriya |
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| description | Abstract Background Major lower limb amputation (MLLA) is a life-saving procedure with significant morbidity and mortality. The objectives of this study were to determine the incidence of 30-day mortality, perioperative complications, and predictive risk factors of mortality in MLLA patients. Methods This retrospective cohort study included patients undergoing MLLA at The Aga Khan University Hospital, Pakistan, from January 2018 to December 2022. Data was collected using chart reviews and analyzed via Stata 15. Demographic, clinical, and procedural variables were examined. Predictive factors for 30-day mortality were assessed using Firth logistic regression. Results Among 286 patients, the mean age was 49.4 ± 20.9 years, and 79.4% were male. The leading indications for MLLA were diabetic foot (43.4%) and trauma (23.8%). Thirty-day mortality was 6.6%. Most deaths occurred in patients with diabetic foot (68.4%), chronic kidney disease (31.6%), or ischemic heart disease (36.8%). Below-knee amputation accounted for 68.4% of cases. Postoperative infections (11.2%) and stump necrosis (4.2%) were the most common complications. Multivariable analysis identified chronic kidney disease (OR: 3.613; 95% CI: 1.112–11.739; p = 0.033) and postoperative local wound infection (OR: 3.416; 95% CI: 1.036–11.267; p = 0.044) as significant predictors of 30-day mortality in this cohort. Conclusion MLLA is associated with considerable short-term mortality, particularly among patients with chronic kidney disease and postoperative surgical site infections. These findings emphasize the need for proactive identification of high-risk individuals, optimization of comorbid conditions, especially renal function, and strengthening perioperative infection control practices to improve patient outcomes in resource-limited settings. |
| format | Article |
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| institution | Kabale University |
| issn | 1471-2482 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
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| series | BMC Surgery |
| spelling | doaj-art-10294bb6b71e4913834d8a98249c1ca12025-08-20T03:45:44ZengBMCBMC Surgery1471-24822025-07-012511810.1186/s12893-025-03013-5Predictors of 30-day mortality in major lower limb amputations: insights from a five-year retrospective study in a South Asian LMICMohammad Zakriya0Zia Ur Rehman1Muhammad Anees2Hafsa Shaikh3Adnan Qadir Memon4Nadeem Ahmed Siddiqui5Fareed Shaikh6Department of Surgery, Aga Khan University HospitalDepartment of Surgery, Aga Khan University HospitalDepartment of Surgery, Aga Khan University HospitalDepartment of Surgery, Aga Khan University HospitalMedical College, Aga Khan UniversityDepartment of Surgery, Aga Khan University HospitalDepartment of Surgery, Aga Khan University HospitalAbstract Background Major lower limb amputation (MLLA) is a life-saving procedure with significant morbidity and mortality. The objectives of this study were to determine the incidence of 30-day mortality, perioperative complications, and predictive risk factors of mortality in MLLA patients. Methods This retrospective cohort study included patients undergoing MLLA at The Aga Khan University Hospital, Pakistan, from January 2018 to December 2022. Data was collected using chart reviews and analyzed via Stata 15. Demographic, clinical, and procedural variables were examined. Predictive factors for 30-day mortality were assessed using Firth logistic regression. Results Among 286 patients, the mean age was 49.4 ± 20.9 years, and 79.4% were male. The leading indications for MLLA were diabetic foot (43.4%) and trauma (23.8%). Thirty-day mortality was 6.6%. Most deaths occurred in patients with diabetic foot (68.4%), chronic kidney disease (31.6%), or ischemic heart disease (36.8%). Below-knee amputation accounted for 68.4% of cases. Postoperative infections (11.2%) and stump necrosis (4.2%) were the most common complications. Multivariable analysis identified chronic kidney disease (OR: 3.613; 95% CI: 1.112–11.739; p = 0.033) and postoperative local wound infection (OR: 3.416; 95% CI: 1.036–11.267; p = 0.044) as significant predictors of 30-day mortality in this cohort. Conclusion MLLA is associated with considerable short-term mortality, particularly among patients with chronic kidney disease and postoperative surgical site infections. These findings emphasize the need for proactive identification of high-risk individuals, optimization of comorbid conditions, especially renal function, and strengthening perioperative infection control practices to improve patient outcomes in resource-limited settings.https://doi.org/10.1186/s12893-025-03013-5Major lower limb amputation30-day mortalityChronic kidney diseaseSurgical site infectionDiabetic footPerioperative complications |
| spellingShingle | Mohammad Zakriya Zia Ur Rehman Muhammad Anees Hafsa Shaikh Adnan Qadir Memon Nadeem Ahmed Siddiqui Fareed Shaikh Predictors of 30-day mortality in major lower limb amputations: insights from a five-year retrospective study in a South Asian LMIC BMC Surgery Major lower limb amputation 30-day mortality Chronic kidney disease Surgical site infection Diabetic foot Perioperative complications |
| title | Predictors of 30-day mortality in major lower limb amputations: insights from a five-year retrospective study in a South Asian LMIC |
| title_full | Predictors of 30-day mortality in major lower limb amputations: insights from a five-year retrospective study in a South Asian LMIC |
| title_fullStr | Predictors of 30-day mortality in major lower limb amputations: insights from a five-year retrospective study in a South Asian LMIC |
| title_full_unstemmed | Predictors of 30-day mortality in major lower limb amputations: insights from a five-year retrospective study in a South Asian LMIC |
| title_short | Predictors of 30-day mortality in major lower limb amputations: insights from a five-year retrospective study in a South Asian LMIC |
| title_sort | predictors of 30 day mortality in major lower limb amputations insights from a five year retrospective study in a south asian lmic |
| topic | Major lower limb amputation 30-day mortality Chronic kidney disease Surgical site infection Diabetic foot Perioperative complications |
| url | https://doi.org/10.1186/s12893-025-03013-5 |
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