The Effect of Revascularization versus Amputations on Patient Mental Health in the Early Postoperative Period: A Prospective Observational Cohort Study.
How Saw Keng M, Mohideen A, et al. • Annals of vascular surgery • 2026
Amputation negatively affects the patient's mental and psychological health as compared to revascularization, with significantly higher postoperative depression and anxiety scores in the major lower limb amputation group.
Key Findings
Results
Major lower limb amputation (MLLA) was associated with higher postoperative depression scores compared to revascularization.
Median postoperative depression scores were 9 (range 8-13) for the amputation group versus 4 (range 2-7) for the revascularization group.
Median preoperative depression scores were 8 (range 5-11) for amputations and 6 (range 2-8) for revascularization, indicating higher baseline scores in the amputation group.
The difference in postoperative depression scores between groups was statistically significant (P < 0.05, 95% confidence interval).
The amputation group's depression scores increased from pre- to postoperative period, while the revascularization group's scores decreased.
Results
Major lower limb amputation was associated with higher postoperative anxiety scores compared to revascularization.
Median postoperative anxiety scores were 9 (range 5-11) for the amputation group versus 5 (range 2-9) for the revascularization group.
Median preoperative anxiety scores were 11 (range 6-13) for amputations and 6 (range 2-10) for revascularization.
The difference in postoperative anxiety scores between groups was statistically significant (P < 0.05, 95% confidence interval).
The revascularization group showed a decrease in anxiety scores postoperatively, while the amputation group also showed a decrease but maintained substantially higher scores.
Results
All preoperative and postoperative Hospital Anxiety and Depression Scale (HADS) scores were significantly different between the two intervention groups.
Scores were assessed using the Hospital Anxiety and Depression Scale (HADS) at 1-week pre-intervention and 6-8 weeks post-intervention.
All comparisons between groups reached statistical significance at P < 0.05 with 95% confidence intervals.
This finding applied to both depression and anxiety subscales at both time points.
The study was a prospective observational cohort design at a tertiary referral center.
Results
The amputation group had a longer median inpatient admission length of stay compared to the revascularization group.
Median inpatient admission days were 14 (IQR 9-21) for the amputation group versus 10 (IQR 5-21) for the revascularization group.
The difference in length of stay between groups was statistically significant (P = 0.04).
Longer hospitalization in the amputation group may have contributed to differences in psychological outcomes.
Methods
The study cohort had a high burden of comorbidities, with diabetes, hypertension, ischemic heart disease, and prior revascularization being common.
A total of 122 patients were included: 73 in the revascularization group and 49 in the amputation group.
57.4% of patients had diabetes, 43.4% had hypertension, and 31.1% had ischemic heart disease.
42.6% of patients had undergone previous revascularization interventions.
Data were also collected on previous psychological issues, previous amputations, perioperative pain, and rehospitalization.
Patients were enrolled between January and June 2021 at a tertiary referral center.
What This Means
This research suggests that the type of surgery performed for peripheral vascular disease—a condition where blood flow to the limbs is reduced—has a meaningful impact on patients' mental health in the weeks following the procedure. Researchers followed 122 patients who either had revascularization (procedures to restore blood flow, either through open surgery or minimally invasive techniques) or major lower limb amputation. They measured depression and anxiety using a standardized questionnaire called the Hospital Anxiety and Depression Scale one week before and six to eight weeks after surgery. Patients who underwent amputation started with higher levels of anxiety and depression before surgery and saw their depression worsen afterward, while patients who had revascularization procedures tended to see improvements in both anxiety and depression scores after their surgery.
The differences in mental health outcomes between the two groups were statistically significant at all measured time points. Patients who had amputations also stayed in the hospital longer on average (14 days versus 10 days), which may have further affected their psychological well-being. The patient population was medically complex, with more than half having diabetes and many having multiple cardiovascular conditions or prior vascular procedures.
This research suggests that amputation carries a significant psychological burden beyond the physical impact of limb loss, and that preserving the limb through revascularization, when medically feasible, may help protect patients' mental health in the early recovery period. These findings highlight the importance of incorporating mental health monitoring and support into the care of patients undergoing major vascular procedures, particularly those facing amputation.
How Saw Keng M, Mohideen A, Rahim A, Hammoda M, Mittapalli D. (2026). The Effect of Revascularization versus Amputations on Patient Mental Health in the Early Postoperative Period: A Prospective Observational Cohort Study.. Annals of vascular surgery. https://doi.org/10.1016/j.avsg.2026.01.026