Wound Healing in Older Adults After Major Lower Extremity Amputation

Maja Wichhart Donzo; Nathaniel Forrester; Chengcheng Hu; Brandi M Mize; Yazan Duwayri; Camille P Vaughan; Olamide Alabi

doi:10.1016/j.avsg.2024.12.066

Wound Healing in Older Adults After Major Lower Extremity Amputation

Ann Vasc Surg. 2025 Jan 21:S0890-5096(25)00017-2. doi: 10.1016/j.avsg.2024.12.066. Online ahead of print.

Authors

Maja Wichhart Donzo¹, Nathaniel Forrester¹, Chengcheng Hu², Brandi M Mize³, Yazan Duwayri⁴, Camille P Vaughan⁵, Olamide Alabi⁶

Affiliations

¹ Emory University School of Medicine.
² Department of Surgery, Emory University School of Medicine.
³ Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Emory University School of Medicine; Surgical and Perioperative Care, Atlanta VA Healthcare System.
⁴ Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Emory University School of Medicine.
⁵ Birmingham/Atlanta VA Geriatric Research Education and Clinical Center; Division of Geriatrics & Gerontology, Department of Medicine, Emory University School of Medicine.
⁶ Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Emory University School of Medicine; Surgical and Perioperative Care, Atlanta VA Healthcare System. Electronic address: [email protected].

PMID: 39848463
DOI: 10.1016/j.avsg.2024.12.066

Abstract

Introduction: The higher prevalence of multiple chronic conditions and frailty among older adults may increase the physiologic demand required for wound healing after a major lower extremity amputation (LEA). After below knee amputations (BKA), patients generally have improved prosthetic fitting rates, postoperative ambulation, and quality of life compared to an above knee amputation (AKA). However, the benefit of a BKA must be weighed against the risk of wound complications. The purpose of this study is to examine the association between advanced age and wound healing in our contemporary cohort of patients who underwent LEA.

Methods: Our study reviewed all patients who received LEA at two major academic healthcare systems between 1/2015 and 12/2022. Patients with prior ipsilateral LEA were excluded. The exposure of interest was advanced age, defined as age over 80 years old, and the primary outcome was time to wound healing (defined as clinical documentation of a healed amputation incision). Chi-squared test was used to evaluate advanced age and prosthetic fitting after LEA and Cox proportional hazard models were fit to examine the relationship between advanced age and time to wound healing after a LEA.

Results: Among 597 patients who underwent LEA, 8.9% (n=53) were over the age of 80. Over one-third of all patients underwent AKA (n= 235, 39.4%) and patients with advanced age represented 12.3% of this group. There was no statistically significant difference detected between the proportion of those with advanced age who were fit for prosthetic compared to those under age 79 who were fit for prosthetic (47.1% vs 58.5%, p=0.11). The median time to wound healing was faster among those with advanced age, even when stratified by level of LEA (Table 1). Advanced age was associated with faster wound healing (hazard ratio [HR] 1.42; 95% CI, 1.06-1.87).

Conclusion: In our cohort of patients, those with advanced age healed faster than their younger counterparts at both levels of LEA and were equally likely to receive a prosthetic after LEA. Age alone should not be used as a factor in determining eligibility to undergo LEA or receipt of prosthetic. Future studies will evaluate other clinical characteristics that are associated with successful wound healing among adults 80 and older.