Long-term Functional Outcomes Of Vascular Amputees Utilizing The Lower Extremity Amputation Pathway (LEAP)

Enhanced recovery after surgery (ERAS) pathways lead to improve perioperative outcomes for vascular amputees; however, long-term data and functional outcomes are lacking. This study evaluated patients treated by the Lower Extremity Amputation Pathway (LEAP) and identified predictors of ambulation. A retrospective review of LEAP patients who underwent major amputation from 2016 to 2022 for WIfI Stage V disease was performed. LEAP patients were matched 1:1 with retrospective controls (NOLEAP) by hospital, need for guillotine amputation, and final amputation type (above- vs below-knee). Primary endpoint was K-level (amputee functional classification) at last follow-up. A total of 126 amputees (63 LEAP and 63 NOLEAP) were included. Seventy-one percent were male, and 49% were Hispanic, with a mean state area deprivation index of 9 of 10. There were no differences in baseline demographics or comorbidities (Table I). All patients had a K level >0 (ambulatory) prior to amputation and an average modified frailty index of 4. Mean follow-up was 17 months. Compared with NOLEAP patients, LEAP patients were more likely to receive a prosthesis (86% vs 44%; P > .001). LEAP patients were more likely to have K level>0 (60% vs 25%; P = .003). On multivariable logistic regression, participation in LEAP increased the odds of K level >0 at follow-up by 5.8-fold (odds ratio, 5.8; 95% confidence interval, 2.5-13.6). Patients with a K level >0 had significantly higher survival at 4 years (93% vs 59%; P = .001). In a Cox proportional hazards model, adjusted for demographics, co-morbidities and amputation level, a K level of >0 at follow-up was associated with an 88% reduction in the risk of mortality compared with K level = 0 (Fig 1). LEAP leads to improved ambulation with a prosthesis in a socioeconomically disadvantaged and frail patient population. Patients with a K level >0 (ambulatory) have significantly improved mortality.TableBaseline demographics and perioperative careLEAP (n = 63)Control (n = 63)P valueDemographics/comorbidities Age, years63 ± 12.561 ± 12.8.60 Male sex46 (73)44 (70).69 Body mass index, kg/m227.1 ± 6.528.2 ± 7.2.38 Hispanic ethnicity35 (56)27 (43).47 State area deprivation index9.39.7.27 Modified frailty index Preoperative K level.61113 (21)17 (27)217 (27)18 (26)333 (52)28 (44) Dialysis-dependent15 (24)16 (25).83 Amputation type1.00Below knee48 (76)48 (76)Above knee15 (24)15 (24) Subsequent contralateral major amputation7 (11)11 (17).30 Subsequent contralateral CLTI29 (46)32 (51).59Perioperative amputation care Locoregional nerve block47 (75)16 (25)<.001 Perioperative counseling63 (100)9 (14)<.001 Postoperative gabapentin50 (79)31 (50)<.001 Phantom or residual limb pain3 (5)9 (21).02 Received prosthesis54 (86)28 (44)<.001Primary outcome K level >038 (60)16 (26)<.001CLTI, Chronic limb-threatening ischemia; LEAP, Lower Extremity Amputation Pathway.Data are presented as number (%) or mean ± standard deviation. Open table in a new tab