LAUSR

Objective: Preoperative clinical frailty is increasingly used as a surrogate for predicting postoperative outcomes. Patients undergoing major lower extremity amputation (LEA) carry a high risk of perioperative morbidity and mortality, including high 30‐day mortality and readmission rates. We hypothesized that preoperative frailty would be associated with an increased risk of postoperative mortality and readmission. Methods: A retrospective review was performed for all patients who underwent transfemoral or transtibial amputation for any indication within a multi‐institution system during a 5‐year period. Standard demographics and all components of the Modified Frailty Index (mFI) were used to determine preoperative frailty status for each patient. The primary outcome was 30‐day mortality, with secondary outcomes of 30‐day readmission, unplanned revision, and composite adverse events. Results: Among 379 patients who underwent LEA, the overall readmission and mortality rates for the group were 22.69% and 6.06%, respectively. Readmission rates increased with increasing mFI score: rates were 8.6%, 13.5%, 16.3%, 19.7%, 31.4%, and 37.0% for mFI scores of 0, 1, 2, 3, 4, and ≥5, respectively (P = .015). On multivariate logistic regression, only mFI (odds ratio, 1.49, 95% confidence interval, 1.24–1.77) and sex (odds ratio, 1.81, 95% confidence interval, 1.00–2.98) were significant predictors of 30‐day readmission. Conclusions: Preoperative clinical frailty is associated with an increased 30‐day readmission rate in patients undergoing LEA and should be incorporated into preoperative counseling and risk stratification, as well as postoperative planning and care.