The role of non-invasive vascular assessment prior to lower extremity amputation

ObjectiveTo compare outcomes between patients who underwent preoperative non-invasive testing and those who did not prior to all-level lower extremity amputation (LEA).MethodsA retrospective analysis of patients undergoing LEA between April 1st 2019 and June 30th 2023 at an acute care facility was performed and relevant demographic and perioperative data collected. The primary endpoint was the association of preoperative non-invasive testing on MALE and MACE.Results188 patients who underwent all-level LEA were included and stratified into two groups: those who had preoperative non-invasive testing (52.7%; <i>n</i> = 99; <i>p</i> < .01) and those who did not (Groups A and B, respectively). Group A demonstrated higher minority representation (<i>p</i> = .04), pre-existing vascular disease (<i>p</i> < .01), hypertension (<i>p</i> < .01), and renal and cardiac comorbidities (both <i>p</i> < .01).Chi-squared analysis between groups demonstrated no significant difference in all-level LEA for outcomes of postoperative revascularization (<i>p</i> = .63), re-amputation (major or all-level; <i>p</i> = .98 and <i>p</i> = .78, respectively), nor any differences in wound complications (<i>p</i> = .79) or mortality (<i>p</i> = .37). In sub-analyses for major and minor amputations, there remained no significant differences in major re-amputation (<i>p</i> = .69 and <i>p</i> = .27, respectively), 30-day wound complications (<i>p</i> = .44 and <i>p</i> = .65, respectively), or MACE (<i>p</i> = .50 and <i>p</i> = .93, respectively) between groups.ConclusionsAuthors note infrequent use of non-invasive testing prior to LEA, and similar MALE and MACE outcomes between groups with potential benefit in medically vulnerable cohorts. With a lack of established guidelines on preoperative workup prior to LEA, additional prospective studies with matched cohorts and similar endpoints may promote algorithms to optimize perioperative outcomes.