Mental Health Predicts Function More Than Intervention In Patients Undergoing Surgery For Chronic Lower Extremity Wounds

PURPOSE: In patients with lower extremity wounds, our multidisciplinary team considers various factors, including function and patient preference, to determine the optimal intervention. We seek to compare patient-reported outcomes measures (PROMS) and complication rates of midfoot amputation to below-knee amputation (BKA). METHODS: A single-center retrospective cohort study was performed from 2017 to 2023 of adult patients undergoing midfoot (Lisfranc or Chopart) amputation or BKA. The Lower Extremity Functional Scale (LEFS), PROM Information System Pain Intensity (PROMIS-3a), Self-Reporting Questionnaire-20 (SRQ-20), and Connor-Davidson Resilience Scale (CD-RISC) were collected at least 6 months after surgery. RESULTS: A total of 73 ambulatory patients were included: 18 underwent midfoot amputation (6 Lisfranc and 12 Chopart), and 55 transtibial. The average age was 62.5 ± 12.0 years with an average Charlson Comorbidity Index of 5.0 [IQR: 4.0] and a median follow-up duration of 40.6 [27.8] months. Complication rates were greater among midfoot amputees, with higher rates of recurrence requiring revision surgery (44.4% vs 18.2%, p = 0.025). PROMs were similar between groups. Multivariate regression analysis revealed that function was independently associated with peripheral vascular disease (B = -10.1, p = 0.047) and psychological distress (B: -2.4, p = 0.002), but not amputation type (p = 0.978). Finally, BKA was independently associated with both increased psychological distress (B: 3.5, p = 0.005) and increased resilience (B: 1.3, p = 0.011). CONCLUSION: With a team-based approach that prioritizes function and patient preference, patient-reported function is impacted by comorbidity and mental health, not by amputation level. *Source: https://ps-rc.org/meeting/Program/2026/EP77.cgi*