{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T01:11:49Z","timestamp":1788052309741,"version":"build-2784847793"},"reference-count":18,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Major lower extremity amputations (LEA) are frequently performed by vascular, trauma, and orthopedic surgeons, yet comparative outcomes across services and the role of frailty remain unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>We conducted a single-center retrospective review of adults undergoing major LEA (above-knee, through-knee, and below-knee) from 2015-2022. Frailty was assessed using the 5-factor modified Frailty Index (mFI-5). Outcomes included complications, length of stay (LOS), readmission, re-amputation, mortality, and prosthetic ambulation. We evaluated 30-day return to the operating room (RTOR) overall and separated planned staged open guillotine amputation (OGA)-to-closure returns from unplanned RTOR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 684 patients (689 LEAs), vascular surgery (VS) performed 44% of procedures, trauma surgery (TS) 37%, and orthopedic surgery (OS) 19%. Median LOS was 14 days and 30-day mortality was 10.8%; 36% achieved prosthetic ambulation. OS had higher ambulation than VS and TS in both non-frail and frail subgroups. Overall, 30-day RTOR differed by service and was highest after TS; however, these differences were largely attributable to planned staged OGA-to-closure returns, while unplanned RTOR did not significantly differ by service. On multivariable analysis, both VS and TS had lower odds of prosthetic ambulation than OS (adjusted OR \u22480.34).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Surgical service line and frailty are associated with outcomes after major LEA. Differences in ambulation, particularly among non-frail patients, suggest that service-specific pathways and perioperative processes may influence functional recovery and represent targets for standardized LEA pathways.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348261429431","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T17:06:06Z","timestamp":1774544766000},"page":"2313-2320","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Association of Surgical Service Line and Frailty with Outcomes after Major Lower Extremity Amputation"],"prefix":"10.1177","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-9641-341X","authenticated-orcid":false,"given":"Allison","family":"Karwoski","sequence":"first","affiliation":[{"name":"Department of Surgery, University of Maryland School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eyerusalem","family":"Workneh","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Maryland School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Som","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Maryland School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke","family":"Pitsenbarger","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Maryland School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Chao","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Maryland School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nora","family":"Dunlap","sequence":"additional","affiliation":[{"name":"University of Maryland Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khanjan H.","family":"Nagarsheth","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Maryland School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2007.11.005"},{"key":"e_1_3_7_3_2","unstructured":"Molina CS Faulk JB. Lower Extremity Amputation. [Updated 2022 Aug 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK546594\/"},{"key":"e_1_3_7_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007611-200208000-00018"},{"key":"e_1_3_7_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005768-199911001-00025"},{"issue":"2","key":"e_1_3_7_6_2","first-page":"1","article-title":"State-specific prevalence of selected health behaviors, by race and ethnicity--Behavioral risk factor surveillance system, 1997","volume":"49","author":"Bolen JC","year":"2000","unstructured":"Bolen JC, Rhodes L, Powell-Griner EE, Bland SD, Holtzman D. State-specific prevalence of selected health behaviors, by race and ethnicity--Behavioral risk factor surveillance system, 1997. 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