Does Specialty Matter? A Comparison of Early Postoperative Clinical Outcomes Following Lower Extremity Amputation Between Orthopaedic and Vascular Surgeons

BACKGROUND: Lower extremity amputation (LEA) is performed by diverse specialties, including orthopaedic surgery and vascular surgery; whether outcomes differ by specialty remains uncertain. This study compared early postoperative outcomes after LEA performed by orthopaedic and vascular surgeons. METHODS: Patients who underwent LEA surgeries were identified within the National Surgical Quality Improvement Program database. National Surgical Quality Improvement Program was queried for above-knee amputation, below-knee amputation, and foot amputations performed by orthopaedic or vascular surgeons. Patients were matched in a 1:1 ratio using propensity scores using a mixed exact/caliper approach. Primary outcomes were 30-day mortality, readmission, and revision surgery; secondary outcomes included cardiac, pulmonary, wound-related issues, and discharge disposition. RESULTS: A total of 26,925 LEA cases were identified. After propensity matching, 3,580 cases remained: orthopaedic surgery 1790 versus vascular surgery 1790, including 3,180 matched below-knee amputation, 806 matched above-knee amputation, and 334 matched foot amputations. Final cohorts had a similar distribution of demographic variables, indicating appropriate matching. Mortality of 4.0% versus 4.0%, readmission of 10.7% versus 11.7%, and revision surgery of 7.6 versus 8.3% were equivalent between orthopaedics and vascular surgery, respectively. The vascular cohort demonstrated higher rates of any postoperative complication: the sum of secondary outcomes (77.9% vs 70.4%; P < 0.001), driven primarily by increased non-home discharge (69.7% vs 60.8%) and transfusion within 72 hours (19.5% vs 16.3%). When non-home discharge was removed, there was no difference in early postoperative complication (32.2% vs 35.5%; P = 0.382). By contrast, the orthopaedic group had slightly higher rates of organ/space infection (4.1% vs 2.2%; P = 0.001) and postoperative pneumonia (3.8% vs 2.5%; P = 0.029), consistent with the higher proportion of contaminated/dirty wounds: 44.4% versus 36.0% and longer surgical duration: 79.5 ± 43.5 versus 68.3 ± 46.1 observed in this group. CONCLUSIONS: The present analysis represents the first matched comparison of LEA outcomes by surgical specialty. When baseline patient risk is balanced, orthopaedic and vascular surgeons achieve comparable 30-day major outcomes: mortality, readmission, and revision surgery following LEA. Residual differences in complication profiles appear driven by clinical context, such as wound class, transfusion exposure, and rehabilitation needs, rather than by specialty itself. LEVEL OF EVIDENCE: Level III.