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. 2025 May 17;9(4):102855.
doi: 10.1016/j.rpth.2025.102855. eCollection 2025 May.

Post-below-knee amputation venous thromboembolism and mortality in United States veterans

Khanh P Nguyen  1   2   3 , Joshua B Gruber  1 , Megan L Mertzel  1   2 , Cecelia Madison  1 , Reid Thompson  1 , Kenneth Gundle  1 , Scott Damrauer  4 , Kristen M Sanfilippo  5   6
Affiliations

Post-below-knee amputation venous thromboembolism and mortality in United States veterans

Khanh P Nguyen et al. Res Pract Thromb Haemost. .

Abstract

Background: Patients who undergo below-knee surgical amputation (BKA) are at risk of postoperative venous thromboembolism (VTE). Limited prior studies quantified the rate of VTE post-BKA or the association of VTE with survival in this population.

Objectives: We aimed to assess the incidence of post-BKA VTE and the association with all-cause mortality in a cohort of United States veterans.

Methods: This was a retrospective cohort study of veterans who underwent surgical BKA between October 2016 and January 2023. We identified VTE within 90 days post-BKA using a previously validated algorithm combining International Classification of Diseases codes with a new anticoagulant prescription, placement of an inferior vena cava filter, or death within 30 days. A time-dependent Cox proportional hazard model tested the association between VTE and death while adjusting for potential confounders. A sensitivity analysis removed individuals categorized as having an acute VTE based on the International Classification of Diseases for VTE plus death within 30 days.

Results: A total of 6305 patients underwent a first-time surgical BKA. Of these, 132 experienced a VTE within 90 days post-BKA. Younger age was associated with a reduced risk of post-BKA VTE. After adjusting for confounders, VTE within 90 days of BKA was associated with a 3-fold increase in mortality (adjusted hazard ratio, 3.17, 95% CI, 2.12-4.17).

Conclusion: Patients who had a VTE within 90 days of BKA had a higher mortality than those without VTE post-BKA. Future studies are warranted to confirm these findings and investigate strategies to prevent post-BKA VTE.

Keywords: risk factors; surgical amputation; survival analysis; venous thromboembolism; veterans.

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Figures

Figure 1
Figure 1
Consolidated Standards of Reporting Trials (CONSORT) diagram of the study cohort. BKA, below-knee amputation; BMI, body mass index; VTE, venous thromboembolism.
Figure 2
Figure 2
Cumulative incidence curve displaying the time between below-knee amputation (BKA) and the venous thromboembolism (VTE) event.
Figure 3
Figure 3
Cumulative incidence curve comparing the overall survival between patients who had a venous thromboembolism (VTE) event within 90 days post–below-knee amputation (BKA) vs patients who did not have a VTE event within 90 days post-BKA.
See this image and copyright information in PMC

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