Postoperative Psychiatric Outcomes After Upper-Extremity Amputations

J Hand Surg Am. 2025 Apr 26:S0363-5023(25)00135-2. doi: 10.1016/j.jhsa.2025.03.008. Online ahead of print.

ABSTRACT

PURPOSE: Upper-extremity amputations alter patient form and, in cases of proximal amputation, may diminish overall function. Psychological outcomes following these procedures have been evaluated primarily on a single-institution basis. This study aimed to evaluate the incidence of psychiatric conditions following upper-extremity amputation on a population-wide basis.

METHODS: The TriNetX database was queried for all patients treated for upper-extremity amputations between January 1, 2010, and December 31, 2022. Preoperative and date-of-surgery diagnoses were collected to identify conditions preceding amputation. The 3-year incidence of mental health conditions was evaluated based on International Classification of Diseases codes. Chi-squared analyses were used to evaluate incidence between amputation levels. Odds ratios were used to compare outcome rates relative to the general population, as well as against that of the general, upper extremity surgical population.

RESULTS: A total of 25,091 patients underwent 25,415 amputations during our period of analysis. This 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. Except for general anxiety disorder, the incidence of all psychiatric outcomes was higher relative to the general population. Compared to patients undergoing nonamputation upper extremity surgical procedures, matched analyses revealed increased odds of psychiatric illness at all amputation levels proximal to the phalanges.

CONCLUSIONS: Approximately one in six patients who undergo an upper extremity amputation develop a psychiatric condition within 3 years, at an increased rate compared to the general population. Patients with more proximal amputations face a greater burden of psychiatric illness compared to those with more distal amputations.

TYPE OF STUDY/LEVEL OF EVIDENCE: Prognosis IIc.

PMID:40285766 | DOI:10.1016/j.jhsa.2025.03.008