Previous reports correlating renal function and reamputation after transmetatarsal amputation (TMA) have been mixed. This study aims to evaluate renal function as a factor for reamputation after initial TMA during the perioperative period in a large population database.

Patients who underwent TMA were identified in the American College of Surgeons-National Surgical Quality Improvement Program® database. Reamputation was defined as unplanned TMA or higher-level amputation in the 30-day perioperative period. Glomerular filtration rate (eGFR) was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.

Of 1,775, the rate of reamputation was 6.5%. Reamputation was correlated with higher white blood cell counts (p<.00001), greater serum creatinine (p=.021), higher blood urea nitrogen (p=.021), type of glycemic control (p=.002), stage of CKD (p=.003), and dialysis (p=.001). CKD stage was directly associated with reamputation rates (p=.003) and mortality (p<.00001).

In the current study, CKD predicted reamputation after TMA and 30-day mortality. Our findings corroborate previous reports correlating dialysis-dependent renal failure and mortality. Whether patients in certain stages of CKD would achieve better outcomes with higher-level amputation rather than a TMA requires further study.


J. Ahn: None. K.M. Raspovic: None. T. Lalli: None. G.T. Liu: Consultant; Self; Gramercy Extremity Orthopedics. M.D. VanPelt: None. D. Wukich: None.

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