DOI: 10.1093/bjs/znad258.761 ISSN:

885 Survival After Major Amputation in Elderly Patients

J Mackay, L Hanna, M Edwards
  • Surgery



Conduct a retrospective analysis of survival of patients >65-years who have undergone a major amputation for chronic limb threatening ischaemia (CLTI) in the Sussex Vascular Network.


This audit was registered with the University of Sussex Hospitals audit team (ref number 4654). A database was compiled of all patients who underwent a major amputation within the Sussex Vascular Network between 2016 to 2021 inclusive. Data sources to formulate the population of interest included theatre registry books, operation notes, electronic patient records and death certificates.


A total of 454 patients underwent a major amputation (122 below knee amputation (BKA), 70 through knee amputation (TKA), 262 above knee amputation (AKA)) between 2016 to 2021. The mean age was 77 years (range 65-104). The median survival was 2.98 years. Survival was lower in older patients (>80 years, p = .012) and patients with renal failure (p<.001). Gender and diabetes had no significant effect on survival. Independent predictors of increased hazard of death included increasing age (HR 1.35, p = .030), renal failure (HR 1.56, p = 0.001), heart failure (HR1.68, p = .001) and ischaemic heart disease (HR 2.02, p<.001).


Survival is poor following major amputations in patients with CLTI over the age of 65 years. Strategies to mitigate the burden of co-morbidities are needed to improve the outcome for these patients. Improved case selection is also needed to identify the patients who benefit most from a major amputation, and those who should perhaps be managed conservatively given the limited survival following a major amputation.

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