Health Related Quality of Life Outcomes after Lower Extremity Amputation.

Abstract

Lower limb amputation profoundly impairs health related quality of life (HRQoL), yet comparative data across indications and amputation levels are scarce. This study evaluated EQ-5D-3L outcomes in patients with and without ischaemia undergoing major vs. minor lower extremity amputations. In this retrospective cohort at a German level 1 trauma centre, patients (during 2010 - 2020) were classified by indication (ischaemia vs. trauma, tumour, and or infection) and amputation level (major vs. minor). Between 2023 and 2024, EQ-5D-3L interviews assessed five HRQoL dimensions. Multivariable linear regression identified independent predictors of EQ-5D index scores. Of 1 075 eligible patients, 276 (25.7%) completed EQ-5D: 176 with ischaemia (124 minor and 53 major) and 100 with other indications (55 minor and 44 major). Mobility limitations were more frequent in major vs. minor amputees for both ischaemia (71.7% vs. 62.1%) and other indications (75.0% vs. 41.8%). Self care was least affected (ischaemia majors 47.2% no problems; minors 60.5%; other majors 51.2%; minors 80.0%). Pain or discomfort was reported by 77.4% of ischaemia majors and 52.8% of ischaemia minors, and by 68.2% and 58.2% of other majors and minors, respectively. Anxiety or depression impairment was intermediate across groups. In patients with ischaemia, higher American Society of Anesthesiologists (ASA) score (β = -6.05, p = .001) and dialysis status (β = 3.47, p = .15) strongly predicted EQ-5D, whereas amputation level did not (β = -2.50, p = .32). In patients without ischaemia, coronary heart disease (β = -10.47, p < .001) and major amputation (β = -8.47, p = .006) were key negative predictors. HRQoL impairments after lower limb amputation vary by indication and level, with comorbidity burden, especially ASA score and coronary disease, exerting greater influence than amputation level alone. These findings support multidisciplinary optimisation of systemic health in amputation care.