Incidence and associated risk factors for limb amputation among sepsis survivors in South Korea

PURPOSE: Peripheral gangrene (PG) is a known complication requiring limb amputation among sepsis survivors; however, its incidence and associated risk factors remain controversial. We aimed to examine the incidence of limb amputation among sepsis survivors, and to investigate factors independently associated with limb amputation. METHODS: In this population-based cohort study, data obtained from the South Korean national health insurance service database between 2015 and 2016 were analyzed. A sepsis survivor was defined as someone having survived > 90 days after initiation of treatment for sepsis. RESULTS: Of 19,906 sepsis survivors, 163 (0.8%) had undergone surgical limb amputation. In a multivariable model, male sex (odds ratio [OR] 1.74, 95% confidence interval [CI] 1.26–2.40; P = 0.001), dopamine infusion (OR 1.78, 95% CI 1.22–2.60; P = 0.003), epinephrine infusion (OR 2.04, 95% CI 1.30–3.20; P = 0.002), continuous renal replacement therapy (OR 3.34, 95% CI 2.01–3.20; P < 0.001), diabetes mellitus (DM) without chronic complication (OR 1.73, 95% CI 1.19–2.51; P = 0.004), DM with chronic complication (OR 3.49, 95% CI 2.32–5.26; P < 0.001), and peripheral arterial disease (OR 6.79, 95% CO 3.70–12.46; P < 0.001) were associated with a higher incidence of limb amputation among sepsis survivors. CONCLUSIONS: In South Korea, 0.8% of sepsis survivors underwent limb amputation for the treatment of PG. Furthermore, the incidence of limb amputation was higher among the sepsis survivors having some underlying diseases (DM and peripheral arterial diseases) or receiving certain vasopressor treatments (epinephrine and dopamine). ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00540-020-02858-9) contains supplementary material, which is available to authorized users.