Traumatic lower extremity amputation as a risk factor for venous thromboembolism.

Feb 19, 2024

Experts: Dias Argandykov, Emanuele Lagazzi, Jefferson A Proaño-Zamudio, Wardah Rafaqat, May Abiad, Michael DeWane, Charudutt N Paranjape, Haytham M A Kaafarani, George C Velmahos, John O Hwabejire

This study aimed to evaluate whether lower extremity (LE) amputation among civilian casualties is a risk factor for venous thromboembolism.
All patients with severe LE injuries (AIS ≥3) derived from the ACS-TQIP (2013-2020) were divided into those who underwent trauma-associated amputation and those with limb salvage. Propensity score matching was used to mitigate selection bias and confounding and compare the rates of pulmonary embolism (PE) and deep vein thrombosis (DVT).
A total of 145,667 patients with severe LE injuries were included, with 3443 patients requiring LE amputation. After successful matching, patients sustaining LE amputation still experienced significantly higher rates of PE (4.2% vs. 2.5%, p < 0.001) and DVT (6.5% vs. 3.4%, p < 0.001). A sensitivity analysis examining patients with isolated major LE trauma similarly showed a higher rate of thromboembolic complications, including higher incidences of PE (3.2% vs. 2.0%, p = 0.015) and DVT (4.7% vs. 2.6%, p < 0.001).
In this nationwide analysis, traumatic lower extremity amputation is associated with a significantly higher risk of VTE events, including PE and DVT.

Copyright © 2024 Elsevier Inc. All rights reserved.

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ABOUT THE EXPERTS

Dias Argandykov, Emanuele Lagazzi, Jefferson A Proaño-Zamudio, Wardah Rafaqat, May Abiad, Michael DeWane, Charudutt N Paranjape, Haytham M A Kaafarani, George C Velmahos, John O Hwabejire

Dias Argandykov

Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. Electronic address: https://twitter.com/argandykov.

Emanuele Lagazzi

Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. Electronic address: https://twitter.com/EmanueleLagazzi.

Jefferson A Proaño-Zamudio

Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. Electronic address: https://twitter.com/eljefe_md.

Wardah Rafaqat

Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.

May Abiad

Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.

Michael DeWane

Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. Electronic address: https://twitter.com/michaeldewane.

Charudutt N Paranjape

Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. Electronic address: https://twitter.com/CharuParanjape.

Haytham M A Kaafarani

Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. Electronic address: https://twitter.com/hayfarani.

George C Velmahos

Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.

John O Hwabejire

Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. Electronic address: JHWABEJIRE@MGB.ORG.