Foot & Ankle International - 2017 FAI Supplement - 19S

interphalangeal angle decreased by 0.2° per year (p=0.019).
Progression of the intermetatarsal angle and metatarsus
adductus angle with aging were not statistically significant.
There was a difference in progression of radiographic indices
between older patients (=10 years) and younger patients (<10
years). The hallux valgus angle increased by 1.5° per year
(p<0.001) in younger patients, progression of the hallux valgus angle in older patients was not statistically significant
(p=0.869) as children grew up.
Conclusion: These results suggest that the hallux valgus
angle increased in patients with juvenile hallux valgus under
10 years old, unlike the patients aged 10 or older. We believed
that our results can help surgeons to determine a treatment
strategy that uses the growth potential to achieve correction of
deformity such as lateral hemiepiphyseodesis of the 1st metatarsal to patients with juvenile hallux valgus.

Foot & Ankle International, 38(S1)
DOI: 10.1177/1071100717S00016
©The Author(s) 2017

Risk Factors of Early Complications,
Readmission, and Reoperation After
Below Knee Amputation
David Ciufo, MD, BS, Russell Marchese, BA,
Caroline Thirukumaran, MBBS, PhD, MHA,
Irvin Oh, MD
Category: Diabetes, Hindfoot, Trauma, Limb Salvage
Keywords: BKA amputation reoperation
AOFAS Annual Meeting 2017

Introduction/Purpose: The number of below knee amputation (BKA) patients experiencing complications requiring
readmission and reoperation remains significant despite
improvements in BKA technique and identification of potential hazards. Analysis of this population is critical due to
increased risk of mortality following amputation and the economic burden placed on the healthcare system. With the
introduction of Hospital Readmission Reduction Program,
prevention of early complication and readmission has become
an area of interest for both policy makers and clinicians. The
purpose of this study is to investigate risk factors and comorbidities associated with early occurrences of complication,
unexpected readmission, and unplanned reoperations after
BKA.
Methods: Current Procedural Terminology (CPT) code
27880 was used to retrospectively identify 4,631 below
knee amputation patients between the years 2012 and 2014
from the National Surgical Quality Improvement Program
(NSQIP) database, a nationally collected clinical database.
Primary outcomes of unplanned reoperation or readmission
were investigated, with independent predictors evaluated
using multivariate logistic regression. Secondary outcomes
of interest were mortality and major or minor complications
within 30 days of index procedure. Major complications
included deep surgical site infection (SSI), unplanned intubation, pulmonary embolism, failure to wean, acute renal
failure, cerebrovascular accident, cardiac arrest, myocardial
infarction, deep vein thrombosis, sepsis, shock, wound
dehiscence, and renal insufficiency. Minor complications
included superficial SSI, pneumonia, and urinary tract
infection.
Results: Within 30 days of the 4,631 BKAs, one or more
complications occurred in 858 (18.5%) patients; 12.8%
major and 8.7% minor (Table 1). Unplanned readmission
occurred in 405 (8.75%) patients with SSI being the leading
cause. Patients with significantly increased risk of readmission included age greater than 79 years old, transfer from
another facility, smoking, and bleeding disorder. A total of
446 (9.63%) patients underwent unplanned reoperations. The
30-day mortality rate was 5.14% (n = 238). The most common procedures for unplanned reoperation were above knee
amputation (n = 128, 28.7%), debridement/secondary closure
(n = 114, 25.6%), and revision BKA (n = 46, 10.32%).
Variables resulting in a significantly increased risk of reoperation included transport from another facility, smoking,
bleeding disorder, and preoperative ventilator use.
Conclusion: This study represents the largest multicenter
cohort examining BKA complications, readmission, and
reoperation. Patients that required transport from another
facility, were smokers, or had diagnosed bleeding disorders
experienced the highest risk of reoperation or readmission.
Statistically significant risk factors for reoperation and
19S

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