Psychological outcomes after upper-limb amputation have been evaluated primarily on a single-institution basis, according to a recent study. As a result, the researchers evaluated the population-wide incidence of psychiatric conditions following upper-limb amputation.
They queried the TriNetX database for all patients treated for upper-limb amputations between January 1, 2010, and December 31, 2022, collected preoperative and date-of-surgery diagnoses to identify conditions preceding amputation, and evaluated the three-year incidence of mental health conditions. Chi-squared analyses were used to evaluate incidence between amputation levels, and odds ratios were used to compare outcome rates relative to the general population, and against that of the general, upper-limb surgical population.
A total of 25,091 patients underwent 25,415 amputations during the researcher’s period of analysis. The group consisted of 23,416 transmetacarpal or digital amputations, 956 transforearm or wrist disarticulations, and 1,043 transhumerus or shoulder disarticulations. Traumatic etiologies were the most common across all levels.
Increases in the rate of depression, general anxiety disorder, psychosis, mood disorders, alcohol or opioid abuse, post-traumatic stress disorder, and suicidality were observed in amputations at and proximal to the wrist compared to those isolated within the hand, according to the study. Except for general anxiety disorder, the incidence of all psychiatric outcomes was higher relative to the general population. Compared to patients undergoing nonamputation upper-limb surgical procedures, matched analyses revealed increased odds of psychiatric illness at all amputation levels proximal to the phalanges.
Approximately one in six patients who undergo an upper-limb amputation develop a psychiatric condition within three years, at an increased rate compared to the general population, according to the researchers. Patients with more proximal amputations face a greater burden of psychiatric illness compared to those with more distal amputations, they concluded.
The study, “Postoperative psychiatric outcomes after upper-extremity amputations,” was published in the Journal of Hand Surgery.
