21. A Comparison of Patient-reported Outcome Measures in Patients Undergoing Limb Salvage Techniques Versus Below the Knee Amputation

PURPOSE: For patients with non-healing lower extremity (LE) wounds that require amputation, limb-salvage techniques are used to preserve limb length and potentially function and quality of life (QoL). Choice of limb-salvage approach depends on factors such as baseline function, wound extent, or wound complexity. However, there is a lack of comparative analysis of patient reported outcome measures (PROM) assessing QoL or function for different limb-salvage techniques compared to below-knee amputation (BKA). Thus, the current study compares PROMs of patients who underwent limb salvage surgeries via mid-foot amputation (MFA) or calcanectomy, to those that underwent BKA. METHODS: PROMs were collected via QR code for adult chronic LE wound patients presenting to a tertiary wound center from June 2022 to May 2024. A cross-sectional analysis of patients who underwent MFA (trans-metatarsal, Chopart, Lisfranc), partial or total calcanectomy, or BKA was conducted. The Self-Report Questionnaire (SRQ-20), PROM Information System Pain Intensity (PROMIS-3a), Connor-Davidson Resilience Scale (CD-RISC), and Lower Extremity Functional Scale (LEFS) were completed at 1, 3, and 6 months and 1, 2, and 5 years postoperatively. Patient demographics, comorbidities, and amputation details were collected. RESULTS: Of 251 survey sets, 88 (35.1%) underwent MFA, 23 (9.2%) underwent calcanectomy, and (55.8%) underwent BKA. Median postoperative time points of survey completion between MFA (9.4 months, IQR: 11.9), Calcanectomy (9.4 months, IQR: 19.1), and BKA (11 months, IQR: 16.6) patients were similar (p = 0.704). Most patients were male (n = 80, 72.1%) with an average age of 62 (IQR: 17.2) years and BMI of 28.3 (IQR: 8.1) kg/m2. Comorbidities for MFA, calcanectomy, and BKA patients included diabetes mellitus (77.8% vs 88.9% vs 70.2%; p = 0.448), chronic kidney disease (31.1% vs 33.3% vs 28.1%; p = 0.86), and peripheral vascular disease (PVD; 48.7% vs 55.6% vs 45.6%; P = 0.403). No significant differences were observed between MFA, calcanectomy, and BKA patients in mean overall function (LEFS; 43.4 ± 22.4 vs 40.6 ± 23.6 vs. 47.4 ± 25.1; p = 0.289), psychological distress (SRQ-20; 3.6 ± 3.7 vs 2.7 ± 2.6 vs. 3.1 ± 3.7; p = 0.436), resilience (CD-RISC; 6.8 ± 1.3 vs 7.4 ± 1.1 vs. 6.9 ± 1.6; p = 0.342), but significant difference was observed in mean overall pain intensity (PROMIS-3a;52.3 ± 11.6 vs. 41.5 ± 8.6 vs. 48.6 ± 13.2; p = 0.007). CONCLUSION: Patients receiving MFA, calcanectomy, or BKA for chronic LE wounds achieve similar levels of QoL, resilience, and function postoperatively. This data suggests that there is favorable patient selection for amputation versus limb salvage techniques by a multidisciplinary tertiary limb salvage team that focuses on functional outcomes. A function-guided patient approach aids in selecting the appropriate procedure for the correct patient. Chronically ill populations have similarly reported patient outcomes due to patient-specific indications for surgery, multidisciplinary patient-orientated decision making, and overall care.