Postoperative Psychological Diagnoses after Lower Extremity Amputations

Original Research Article Objective To evaluate the incidence of new psychological diagnoses following lower extremity amputations. Our hypotheses were that patients with amputations will have a higher incidence of new psychological diagnoses; and that higher amputations levels will have a higher incidence of new psychological diagnoses. DESIGN The TriNetX database was queried for patients with lower extremity amputations between January 1 st , 2010 and December 31 st , 2022. The three-year incidences of new psychological diagnoses were measured. Odds ratios (OR) were calculated to compare rates of new psychological diagnoses relative to the general population. Descriptive statistics and chi-squared analyses were used to compare the rates of new psychological diagnoses at different amputation levels. SETTING Retrospective database study PARTICIPANTS Patients 18 - 90 years of age who underwent lower extremity amputation over a thirteen year period INTERVENTIONS none MAIN OUTCOME MEASURES The three-year incidences of depression, generalized anxiety disorder (GAD), psychosis, mood disorder, alcohol abuse, opioid abuse, post-traumatic stress disorder (PTSD), and suicidal ideations/attempts, were evaluated based on International Classification of Diseases (ICD) codes RESULTS A total of 41,775 patients underwent 49,473 amputations during the period of analysis. This group consisted of 12,101 foot or Syme amputations, 23,274 below knee amputations, and 14,098 above knee amputations. The lower extremity amputation group was at higher risk of developing opioid abuse disorder (OR10.83), depression (OR: 8.54), psychosis (OR: 5.45), alcohol abuse (OR: 6.82), mood disorder (OR: 5.04), PTSD (OR: 5.27), suicidal ideation or suicide attempt (OR: 4.65), and GAD (OR: 2.85). CONCLUSIONS The three-year incidence of all new psychological diagnoses was statistically higher in patients who had a lower extremity amputation. We recommend that routine early intervention be considered in lower extremity amputation patients to prevent or minimize these psychological issues.