SUPPLEMENT TO THE CLINICAL PRACTICE GUIDELINE FOR LIMB SALVAGE OR EARLY AMPUTATION e-Appendix • Quality Evaluation • Data Summary • Detailed Data Tables • Excluded Literature • AAOS Approval Bodies Table of Contents Quality Evaluations ............................................................................................................................................................................................................................... 3 Section 1. Smoking-Drugs-Alcohol ........................................................................................................................................................................................................... 6 Section 2. Poly-trauma ........................................................................................................................................................................................................................... 14 PICO 1 ................................................................................................................................................................................................................................................. 14 PICO 2 ................................................................................................................................................................................................................................................. 15 Section 3.1. Psychological Factors ......................................................................................................................................................................................................... 26 Section 3.2. Psychosocial Support ......................................................................................................................................................................................................... 38 Section 4. Rehabilitation ........................................................................................................................................................................................................................ 41 Section 5. Health Scores ......................................................................................................................................................................................................................... 52 PICO 1 ................................................................................................................................................................................................................................................. 52 PICO2 .................................................................................................................................................................................................................................................. 53 Section 6. Insensate/Nerve Injury .......................................................................................................................................................................................................... 63 Section 7. Crushed/Blunt Injury ............................................................................................................................................................................................................. 69 Section 8. Physiologic Viability ............................................................................................................................................................................................................... 70 PICO 1 ................................................................................................................................................................................................................................................. 70 PICO 2 ................................................................................................................................................................................................................................................. 71 Section 9. Comorbidities ........................................................................................................................................................................................................................ 72 Section 10. Vascular Injury ..................................................................................................................................................................................................................... 78 Section 11. Injury Type ........................................................................................................................................................................................................................... 80 Section 12. Amputation/Salvage ............................................................................................................................................................................................................ 83 Section 13. Degloving ............................................................................................................................................................................................................................. 88 Section 14. Operative Complications ..................................................................................................................................................................................................... 89 Section 15. Prosthesis ............................................................................................................................................................................................................................ 90 Section 16. Segmental Bone Loss........................................................................................................................................................................................................... 95 Section 17. Volumetric Muscle Loss ...................................................................................................................................................................................................... 96 Excluded Literature ............................................................................................................................................................................................................................... 98 AAOS CPG Approval Bodies ............................................................................................................................................................................................................ 187 Quality Evaluations Appropriate Representative Reason for Prognostic Factor Outcome Study Confounders Statistical Strength Population Follow Up Loss Measured Measurement Analysis MacKenzie, E. J., High Quality 2006 O'Toole, R. V., High Quality 2008 Allami, M., 2017 Moderate Quality Archer, K. R., 2010 Moderate Quality Bennett, P. M., Moderate Quality 2017 Bosse, M. J., 2005 Moderate Quality Castillo, R. C., Moderate Quality 2008 Ly, T. V., 2008 Moderate Quality MacKenzie, E. J., Moderate Quality 2004 3 Appropriate Representative Reason for Prognostic Factor Outcome Study Confounders Statistical Strength Population Follow Up Loss Measured Measurement Analysis MacKenzie, E. J., Moderate Quality 2005 Masoumi, M., Moderate Quality 2014 Pezzin, L. E., 2000 Moderate Quality Almassi, F., 2010 Low Quality Asensio, J. A., Low Quality 2006 Aydemir, K., 2017 Low Quality Bennett, P. M., Low Quality 2018 Blair, J. A., 2014 Low Quality Bosse, M. J., 2002 Low Quality Burns, T. C., 2012 Low Quality Doucet, J. J., 2011 Low Quality Dickens, J. F., 2013 Low Quality Ellington, J. K., Low Quality 2013 Gailey, R., 2010 Low Quality 4 Appropriate Representative Reason for Prognostic Factor Outcome Study Confounders Statistical Strength Population Follow Up Loss Measured Measurement Analysis Gaunaurd, I. A., Low Quality 2013 Gunawardena, N., Low Quality 2007 Hutchison, T. N., Low Quality 2014 Jain, A., 2013 Low Quality Laferrier, J. Z., Low Quality 2010 Low, E. E., 2017 Low Quality Melcer, T., 2013 Low Quality Melcer, T., 2017 Low Quality Melton, S. M., Low Quality 1997 Stranix, J. T., 2017 Low Quality Webster, C. E., Low Quality 2018 Wen, P. S., 2018 Low Quality Working, Z. M., Low Quality 2017 5 Section 1. Smoking-Drugs-Alcohol Ref. title Quality Patient Outcome RF Type Full RF name N Follo Confounding Statistic Result Author Characteristics Title w-up Adjustment Reported Time Favored Tx time since injury, summary score, treatment, complication, <10 education, Cigarettes pts w/ severe income, race, Multivariate /day leg injuries insurance, Logistic increases resulting in smoking, self- regression, the odds reconstructio Sickness <10 efficacy, social percent of a worse Bosse, M. Low n or impact Smoking/Dr Cigarettes/d 24 support, lawyer difference, 16.6, overall SIP J., 2002 Quality amputation. Profile (SIP) ugs/Alcohol ay 460 mon. hired p-value P<0.05 score time since injury, summary score, treatment, <10 complication, Cigarettes education, /day pts w/ severe Sickness income, race, Multivariate increases leg injuries Impact insurance, Logistic the odds resulting in Profile smoking, self- regression, of a worse reconstructio (Physical <10 efficacy, social percent physical Bosse, M. Low n or function Smoking/Dr Cigarettes/d 24 support, lawyer difference, 16.2,