Risk factors for revision amputation and infection after definitive closure of traumatic amputations: a retrospective cohort study at a Level I academic trauma center.

Purpose: The purpose of this study was to identify risk factors for revision amputation and postoperative infection after definitive closure of traumatic amputations. Methods: We conducted a retrospective cohort study of patients presenting with traumatic lower extremity amputation or injuries requiring amputation during the initial operative intervention at a level one trauma center between January 2005 and April 2024. Patients under 18 or without an acute fracture in the amputated limb were excluded. Collected variables included mechanism of injury, time to antibiotics and debridement, and final amputation level. Computed tomography angiography abnormalities, tourniquet use, gross contamination, injury severity score, and body mass index (BMI) were compared using Fisher exact and Mann-Whitney nonparametric tests. Results: Eighty-six patients (mean age 44.9 ± 16.9 years) met inclusion criteria. Nearly half were smokers (48%) with an average BMI of 29.3 ± 7.1; the median injury severity score was 22. Tourniquets were present on arrival in 40% of cases. Although most presented with tibia-level amputations, 37% ultimately required above- or through-knee amputation. These patients were more likely to have American Society of Anesthesiologists Physical Status scores ≥4 (39% vs 13%, Conclusion: Revision amputation after definitive stump closure was associated with both patient and treatment-related factors, particularly higher BMI and the need for additional debridement. When feasible, preservation of a below-knee amputation was associated with better functional outcomes, underscoring the role of thoughtful surgical planning and attention to infection control in optimizing outcomes after traumatic lower extremity amputation.