An analysis of outcomes of reconstruction or amputation of leg-threatening injuries

Michael J. Bosse, Ellen J Mackenzie, James F. Kellam, Andrew R. Burgess, Lawrence X. Webb, Marc F. Swiontkowski, Roy W. Sanders, Alan L. Jones, Mark P. McAndrew, Brendan M. Patterson, Melissa L. McCarthy, Thomas G. Travison, Renan Carlos Castillo

Research output: Contribution to journalArticle

Abstract

Background: Limb salvage for severe trauma has replaced amputation as the primary treatment in many trauma centers. However, long-term outcomes after limb reconstruction or amputation have not been fully evaluated. Methods: We performed a multicenter, prospective, observational study to determine the functional outcomes of 569 patients with severe leg injuries resulting in reconstruction or amputation. The principal outcome measure was the Sickness Impact Profile, a multidimensional measure of self-reported health status (scores range from 0 to 100; scores for the general population average 2 to 3, and scores greater than 10 represent severe disability). Secondary outcomes included limb status and the presence or absence of major complications resulting in rehospitalization. Results: At two years, there was no significant difference in scores for the Sickness Impact Profile between the amputation and reconstruction groups (12.6 vs. 11.8, P=0.53). After adjustment for the characteristics of the patients and their injuries, patients who underwent amputation had functional outcomes that were similar to those of patients who underwent reconstruction. Predictors of a poorer score for the Sickness Impact Profile included rehospitalization for a major complication, a low educational level, nonwhite race, poverty, lack of private health insurance, poor social-support network, low self-efficacy (the patient's confidence in being able to resume life activities), smoking, and involvement in disability-compensation litigation. Patients who underwent reconstruction were more likely to be rehospitalized than those who underwent amputation (47.6 percent vs. 33.9 percent, P=0.002). Similar proportions of patients who underwent amputation and patients who underwent reconstruction had returned to work by two years (53.0 percent and 49.4 percent, respectively). Conclusions: Patients with limbs at high risk for amputation can be advised that reconstruction typically results in two-year outcomes equivalent to those of amputation.

Original languageEnglish (US)
Pages (from-to)1924-1931
Number of pages8
JournalNew England Journal of Medicine
Volume347
Issue number24
DOIs
StatePublished - Dec 12 2002

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Leg Injuries
Amputation
Sickness Impact Profile
Extremities
Social Support
Limb Salvage
Trauma Centers
Wounds and Injuries
Jurisprudence
Self Efficacy
Poverty
Health Insurance
Compensation and Redress
Health Status
Observational Studies
Smoking
Outcome Assessment (Health Care)
Prospective Studies

ASJC Scopus subject areas

  • Medicine(all)

Cite this

An analysis of outcomes of reconstruction or amputation of leg-threatening injuries. / Bosse, Michael J.; Mackenzie, Ellen J; Kellam, James F.; Burgess, Andrew R.; Webb, Lawrence X.; Swiontkowski, Marc F.; Sanders, Roy W.; Jones, Alan L.; McAndrew, Mark P.; Patterson, Brendan M.; McCarthy, Melissa L.; Travison, Thomas G.; Castillo, Renan Carlos.

In: New England Journal of Medicine, Vol. 347, No. 24, 12.12.2002, p. 1924-1931.

Research output: Contribution to journalArticle

Bosse, MJ, Mackenzie, EJ, Kellam, JF, Burgess, AR, Webb, LX, Swiontkowski, MF, Sanders, RW, Jones, AL, McAndrew, MP, Patterson, BM, McCarthy, ML, Travison, TG & Castillo, RC 2002, 'An analysis of outcomes of reconstruction or amputation of leg-threatening injuries', New England Journal of Medicine, vol. 347, no. 24, pp. 1924-1931. https://doi.org/10.1056/NEJMoa012604
Bosse, Michael J. ; Mackenzie, Ellen J ; Kellam, James F. ; Burgess, Andrew R. ; Webb, Lawrence X. ; Swiontkowski, Marc F. ; Sanders, Roy W. ; Jones, Alan L. ; McAndrew, Mark P. ; Patterson, Brendan M. ; McCarthy, Melissa L. ; Travison, Thomas G. ; Castillo, Renan Carlos. / An analysis of outcomes of reconstruction or amputation of leg-threatening injuries. In: New England Journal of Medicine. 2002 ; Vol. 347, No. 24. pp. 1924-1931.
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AU - Mackenzie, Ellen J

AU - Kellam, James F.

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AU - Webb, Lawrence X.

AU - Swiontkowski, Marc F.

AU - Sanders, Roy W.

AU - Jones, Alan L.

AU - McAndrew, Mark P.

AU - Patterson, Brendan M.

AU - McCarthy, Melissa L.

AU - Travison, Thomas G.

AU - Castillo, Renan Carlos

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N2 - Background: Limb salvage for severe trauma has replaced amputation as the primary treatment in many trauma centers. However, long-term outcomes after limb reconstruction or amputation have not been fully evaluated. Methods: We performed a multicenter, prospective, observational study to determine the functional outcomes of 569 patients with severe leg injuries resulting in reconstruction or amputation. The principal outcome measure was the Sickness Impact Profile, a multidimensional measure of self-reported health status (scores range from 0 to 100; scores for the general population average 2 to 3, and scores greater than 10 represent severe disability). Secondary outcomes included limb status and the presence or absence of major complications resulting in rehospitalization. Results: At two years, there was no significant difference in scores for the Sickness Impact Profile between the amputation and reconstruction groups (12.6 vs. 11.8, P=0.53). After adjustment for the characteristics of the patients and their injuries, patients who underwent amputation had functional outcomes that were similar to those of patients who underwent reconstruction. Predictors of a poorer score for the Sickness Impact Profile included rehospitalization for a major complication, a low educational level, nonwhite race, poverty, lack of private health insurance, poor social-support network, low self-efficacy (the patient's confidence in being able to resume life activities), smoking, and involvement in disability-compensation litigation. Patients who underwent reconstruction were more likely to be rehospitalized than those who underwent amputation (47.6 percent vs. 33.9 percent, P=0.002). Similar proportions of patients who underwent amputation and patients who underwent reconstruction had returned to work by two years (53.0 percent and 49.4 percent, respectively). Conclusions: Patients with limbs at high risk for amputation can be advised that reconstruction typically results in two-year outcomes equivalent to those of amputation.

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