The Risk of Subsequent Amputation Following An Initial Lower Extremity Amputation: A Systematic Review

Purpose: Quantifying subsequent amputation incidence after an initial amputation, whether affecting the ipsilateral or contralateral lower extremity, may enhance decision-making regarding risk reduction. This systematic review sought to determine reamputation risk in patients with vascular disease including diabetes. Methods: Four databases were searched from January 2005 through July 2015. Reviewers screened articles for inclusion criteria: cohort studies, >80% participants with initial amputations due to vascular disease including diabetes, >100 participants. Articles were excluded when >20% of the initial amputations were due to trauma or >5% were due to cancer. Final article inclusion was approved by reviewer consensus. Bias was assessed with the Joanna Briggs Institute Critical Appraisal Tool for cohort studies. Results: Of 365 unique records screened, 43 abstracts reviewed, and 21 full articles reviewed, 15 articles were included. Subsequent amputation was most common in the first year after initial amputation with the rates 13.9% ipsilateral and 7.2% contralateral. Specific risk factors included combined diabetes and peripheral artery disease, renal failure, and coronary disease. Conclusion: The rate of subsequent amputation after primary lower limb amputation is substantial but appears lower than in past decades. Awareness of the problem and potential risk factors may impact clinical decisions regarding patient education and prevention