Post–below-knee amputation venous thromboembolism and mortality in United States veterans
Background: Patients who undergo below-knee surgical amputation (BKA) are at risk of postoperative venous thromboembolism (VTE). Limited prior studies quantified the rate of VTE post-BKA or the association of VTE with survival in this population. Objectives: We aimed to assess the incidence of post-...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-05-01
|
| Series: | Research and Practice in Thrombosis and Haemostasis |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2475037925001797 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849399490046328832 |
|---|---|
| author | Khanh P. Nguyen Joshua B. Gruber Megan L. Mertzel Cecelia Madison Reid Thompson Kenneth Gundle Scott Damrauer Kristen M. Sanfilippo |
| author_facet | Khanh P. Nguyen Joshua B. Gruber Megan L. Mertzel Cecelia Madison Reid Thompson Kenneth Gundle Scott Damrauer Kristen M. Sanfilippo |
| author_sort | Khanh P. Nguyen |
| collection | DOAJ |
| description | Background: Patients who undergo below-knee surgical amputation (BKA) are at risk of postoperative venous thromboembolism (VTE). Limited prior studies quantified the rate of VTE post-BKA or the association of VTE with survival in this population. Objectives: We aimed to assess the incidence of post-BKA VTE and the association with all-cause mortality in a cohort of United States veterans. Methods: This was a retrospective cohort study of veterans who underwent surgical BKA between October 2016 and January 2023. We identified VTE within 90 days post-BKA using a previously validated algorithm combining International Classification of Diseases codes with a new anticoagulant prescription, placement of an inferior vena cava filter, or death within 30 days. A time-dependent Cox proportional hazard model tested the association between VTE and death while adjusting for potential confounders. A sensitivity analysis removed individuals categorized as having an acute VTE based on the International Classification of Diseases for VTE plus death within 30 days. Results: A total of 6305 patients underwent a first-time surgical BKA. Of these, 132 experienced a VTE within 90 days post-BKA. Younger age was associated with a reduced risk of post-BKA VTE. After adjusting for confounders, VTE within 90 days of BKA was associated with a 3-fold increase in mortality (adjusted hazard ratio, 3.17, 95% CI, 2.12-4.17). Conclusion: Patients who had a VTE within 90 days of BKA had a higher mortality than those without VTE post-BKA. Future studies are warranted to confirm these findings and investigate strategies to prevent post-BKA VTE. |
| format | Article |
| id | doaj-art-61d7369b5e5049b8afef787e40d4db33 |
| institution | Kabale University |
| issn | 2475-0379 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Research and Practice in Thrombosis and Haemostasis |
| spelling | doaj-art-61d7369b5e5049b8afef787e40d4db332025-08-20T03:38:19ZengElsevierResearch and Practice in Thrombosis and Haemostasis2475-03792025-05-019410285510.1016/j.rpth.2025.102855Post–below-knee amputation venous thromboembolism and mortality in United States veteransKhanh P. Nguyen0Joshua B. Gruber1Megan L. Mertzel2Cecelia Madison3Reid Thompson4Kenneth Gundle5Scott Damrauer6Kristen M. Sanfilippo7Research & Development, Portland Veterans Administration Health Care System, Portland, Oregon, USA; Department of Vascular Surgery, Oregon Health and Science University, Portland, Oregon, USA; Department of Biomedical Engineering, Oregon Health and Science University, Portland, Oregon, USA; Correspondence Khanh P. Nguyen, Division of Vascular Surgery, Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.Research & Development, Portland Veterans Administration Health Care System, Portland, Oregon, USAResearch & Development, Portland Veterans Administration Health Care System, Portland, Oregon, USA; Department of Vascular Surgery, Oregon Health and Science University, Portland, Oregon, USAResearch & Development, Portland Veterans Administration Health Care System, Portland, Oregon, USAResearch & Development, Portland Veterans Administration Health Care System, Portland, Oregon, USAResearch & Development, Portland Veterans Administration Health Care System, Portland, Oregon, USADepartment of Vascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USADepartment of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA; Department of Hematology & Oncology, Veterans Administration St. Louis Health Care System, St. Louis, Missouri, USABackground: Patients who undergo below-knee surgical amputation (BKA) are at risk of postoperative venous thromboembolism (VTE). Limited prior studies quantified the rate of VTE post-BKA or the association of VTE with survival in this population. Objectives: We aimed to assess the incidence of post-BKA VTE and the association with all-cause mortality in a cohort of United States veterans. Methods: This was a retrospective cohort study of veterans who underwent surgical BKA between October 2016 and January 2023. We identified VTE within 90 days post-BKA using a previously validated algorithm combining International Classification of Diseases codes with a new anticoagulant prescription, placement of an inferior vena cava filter, or death within 30 days. A time-dependent Cox proportional hazard model tested the association between VTE and death while adjusting for potential confounders. A sensitivity analysis removed individuals categorized as having an acute VTE based on the International Classification of Diseases for VTE plus death within 30 days. Results: A total of 6305 patients underwent a first-time surgical BKA. Of these, 132 experienced a VTE within 90 days post-BKA. Younger age was associated with a reduced risk of post-BKA VTE. After adjusting for confounders, VTE within 90 days of BKA was associated with a 3-fold increase in mortality (adjusted hazard ratio, 3.17, 95% CI, 2.12-4.17). Conclusion: Patients who had a VTE within 90 days of BKA had a higher mortality than those without VTE post-BKA. Future studies are warranted to confirm these findings and investigate strategies to prevent post-BKA VTE.http://www.sciencedirect.com/science/article/pii/S2475037925001797risk factorssurgical amputationsurvival analysisvenous thromboembolismveterans |
| spellingShingle | Khanh P. Nguyen Joshua B. Gruber Megan L. Mertzel Cecelia Madison Reid Thompson Kenneth Gundle Scott Damrauer Kristen M. Sanfilippo Post–below-knee amputation venous thromboembolism and mortality in United States veterans Research and Practice in Thrombosis and Haemostasis risk factors surgical amputation survival analysis venous thromboembolism veterans |
| title | Post–below-knee amputation venous thromboembolism and mortality in United States veterans |
| title_full | Post–below-knee amputation venous thromboembolism and mortality in United States veterans |
| title_fullStr | Post–below-knee amputation venous thromboembolism and mortality in United States veterans |
| title_full_unstemmed | Post–below-knee amputation venous thromboembolism and mortality in United States veterans |
| title_short | Post–below-knee amputation venous thromboembolism and mortality in United States veterans |
| title_sort | post below knee amputation venous thromboembolism and mortality in united states veterans |
| topic | risk factors surgical amputation survival analysis venous thromboembolism veterans |
| url | http://www.sciencedirect.com/science/article/pii/S2475037925001797 |
| work_keys_str_mv | AT khanhpnguyen postbelowkneeamputationvenousthromboembolismandmortalityinunitedstatesveterans AT joshuabgruber postbelowkneeamputationvenousthromboembolismandmortalityinunitedstatesveterans AT meganlmertzel postbelowkneeamputationvenousthromboembolismandmortalityinunitedstatesveterans AT ceceliamadison postbelowkneeamputationvenousthromboembolismandmortalityinunitedstatesveterans AT reidthompson postbelowkneeamputationvenousthromboembolismandmortalityinunitedstatesveterans AT kennethgundle postbelowkneeamputationvenousthromboembolismandmortalityinunitedstatesveterans AT scottdamrauer postbelowkneeamputationvenousthromboembolismandmortalityinunitedstatesveterans AT kristenmsanfilippo postbelowkneeamputationvenousthromboembolismandmortalityinunitedstatesveterans |