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Peer-reviewedCC BYBJS open

Short-term outcomes after major lower limb amputation: meta-analysis.

  • Nick Moody1
  • Rhiannon Nielsen2
  • Megan Lyons3
  • Leanne Murphy4
  • Becky Sandford5,6
  • David C Bosanquet7,8
  • Kathryn Chu9
  • Matthew Popplewell1
  • Justine Davies1
9 affiliations
  1. 1Department of Applied Health Sciences, College of Medicine and Health, University of Birmingham, Birmingham, UK.
  2. 2Gwent Vascular Institute, Royal Gwent Hospital, South East Wales Vascular Network, Newport, Wales, UK.
  3. 3Department of Vascular Surgery, Imperial College NHS Trust, London, UK.
  4. 4Department of General Surgery, Lewisham and Greenwich NHS Trust, London, UK.
  5. 5Department of Vascular Surgery, Guy's and St Thomas' NHS Trust, London, UK.
  6. 6Faculty of Life Sciences and Medicine, King's College London, London, UK.
  7. 7South East Wales Vascular Network, University Hospital of Wales, Cardiff, Wales.
  8. 8Division of Population Medicine, Cardiff University, Cardiff, UK.
  9. 9Centre for Global Surgery, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa.
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Abstract

Introduction

Mortality after major lower limb amputation is a key factor in the decision to perform surgery. This review synthesizes the evidence on in-hospital and 30-day postoperative mortality after major amputation.Methods

Electronic databases Medline, Embase, Scopus and African Journals Online were searched using keywords and thesaurus terms in October 2024 and updated in November 2025. Studies published globally and reporting in-hospital or 30-day mortality after major lower limb amputation (defined as at- or above-ankle amputation, or transtibial amputation (TTA) and/or transfemoral amputation (TFA)) and published between 2008 and 2025 were included. Only population level studies were included. Meta-analysis was performed and prediction intervals used to report findings primarily. The Newcastle-Ottawa tool was used to assess the methodological quality of studies.Results

Fifty-two studies were included (1 067 616 patients). Only three studies were from low- and middle-income countries (two from Brazil, one from Togo). Most studies were either from North America (42%) or Europe and Central Asia (36%). Twenty-six studies reported in-hospital mortality and 26 reported 30-day mortality. Prediction intervals were 3.6-24.5% (point estimate 10.0%, 95% confidence interval 8.2% to 12.1%; 664 608), and 4.0-20.4% (point estimate 9.4%, 8.0% to 11.0%; 390 030) for in-hospital and 30-day mortality, respectively. In-hospital mortality prediction intervals were 2.9-12.7% (point estimate 6.2%, 5.1% to 7.7%; 77 204) for TTAs and 5.6-23.3% (point estimate: 11.8%, 9.6% to 14.4%; 78 632) for TFAs. Prediction intervals for 30-day mortality were 2.5-11.6% (point estimate 5.5%, 4.5% to 6.7%; 87 971) for TTAs and 4-26.6% (point estimate 10.9%, 8.3% to 14.2%; 42 145) for TFAs. Heterogeneity was high (> 75%) across all analyses.Conclusion

Most studies reporting short-term outcomes after major lower limb amputation are from high-income countries. Reported mortality is highly variable, but prediction intervals can be used to estimate mortality in future studies and inform shared decision-making.

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Cite

BibTeXRIS
BibTeX
@article{moody2026shortterm,
  title = {{Short-term outcomes after major lower limb amputation: meta-analysis.}},
  author = {Nick Moody and Rhiannon Nielsen and Megan Lyons and Leanne Murphy and Becky Sandford and David C Bosanquet and Kathryn Chu and Matthew Popplewell and Justine Davies},
  journal = {BJS open},
  year = {2026},
  month = sep,
  doi = {10.1093/bjsopen/zrag122},
  url = {https://europepmc.org/article/MED/42925092},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Short-term outcomes after major lower limb amputation: meta-analysis.
AU  - Nick Moody
AU  - Rhiannon Nielsen
AU  - Megan Lyons
AU  - Leanne Murphy
AU  - Becky Sandford
AU  - David C Bosanquet
AU  - Kathryn Chu
AU  - Matthew Popplewell
AU  - Justine Davies
PY  - 2026
DA  - 2026/09/01
JO  - BJS open
DO  - 10.1093/bjsopen/zrag122
UR  - https://europepmc.org/article/MED/42925092
AB  - Introduction  Mortality after major lower limb amputation is a key factor in the decision to perform surgery. This review synthesizes the evidence on in-hospital and 30-day postoperative mortality after major amputation.Methods  Electronic databases Medline, Embase, Scopus and African Journals Online were searched using keywords and thesaurus terms in October 2024 and updated in November 2025. Studies published globally and reporting in-hospital or 30-day mortality after major lower limb amputation (defined as at- or above-ankle amputation, or transtibial amputation (TTA) and/or transfemoral amputation (TFA)) and published between 2008 and 2025 were included. Only population level studies were included. Meta-analysis was performed and prediction intervals used to report findings primarily. The Newcastle-Ottawa tool was used to assess the methodological quality of studies.Results  Fifty-two studies were included (1 067 616 patients). Only three studies were from low- and middle-income countries (two from Brazil, one from Togo). Most studies were either from North America (42%) or Europe and Central Asia (36%). Twenty-six studies reported in-hospital mortality and 26 reported 30-day mortality. Prediction intervals were 3.6-24.5% (point estimate 10.0%, 95% confidence interval 8.2% to 12.1%; 664 608), and 4.0-20.4% (point estimate 9.4%, 8.0% to 11.0%; 390 030) for in-hospital and 30-day mortality, respectively. In-hospital mortality prediction intervals were 2.9-12.7% (point estimate 6.2%, 5.1% to 7.7%; 77 204) for TTAs and 5.6-23.3% (point estimate: 11.8%, 9.6% to 14.4%; 78 632) for TFAs. Prediction intervals for 30-day mortality were 2.5-11.6% (point estimate 5.5%, 4.5% to 6.7%; 87 971) for TTAs and 4-26.6% (point estimate 10.9%, 8.3% to 14.2%; 42 145) for TFAs. Heterogeneity was high (> 75%) across all analyses.Conclusion  Most studies reporting short-term outcomes after major lower limb amputation are from high-income countries. Reported mortality is highly variable, but prediction intervals can be used to estimate mortality in future studies and inform shared decision-making.
SN  - 2474-9842
ER  -