AnesthesiaATLLASNCT07244627
Anaesthetic Technique for Minor Lower Limb Amputation Surgery (ATLLAS)
An observational study of Anesthesia and Amputation; Traumatic, Leg, Lower, run by University Hospitals of North Midlands NHS Trust at 1 site in United Kingdom.
Trial summary
Major lower limb amputation is recognised as a significant cause of morbidity and mortality. In the United Kingdom, 30-day in-hospital mortality is up to 8.7%. Minor lower limb amputations, defined as amputation at or below the ankle, are often considered minor procedures, but mortality at one month is 3.5%, similar… Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Anesthesia, Amputation; Traumatic, Leg, Lower
- How many people
- 300 participants
- Where
- 1 siteUnited Kingdom
- Study dates
- Jan 2026to Jan 2027
- Phase
- Observational
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Study population: Patients in the National Vascular Registry (NVR) database for minor lower limb amputations undertaken between January 2019 and January 2025.
Who may be able to join
- Adult patients (aged 18 and over).
- National Vascular Registry data field - Procedure undertaken - amputation through ankle or below.
- Procedure undertaken between 1st January 2019 and 1st January 2025.
Who cannot join
- Amputations due to trauma, neurological disease or chronic pain
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
United Kingdom1 site
University Hospital of North Midlands
Stoke-on-Trent, Staffordshire, ST4 6QG
Aviva Ogbolosingha, 01782 675380, aviva.ogbolosingha@uhnm.nhs.uk
Tim Scott
About this study
Official title: Anaesthetic Technique for Minor Lower Limb Amputation Surgery (ATLLAS): A Retrospective Review of Outcomes
Major lower limb amputation is recognised as a significant cause of morbidity and mortality. In the United Kingdom, 30-day in-hospital mortality is up to 8.7%. Minor lower limb amputations, defined as amputation at or below the ankle, are often considered minor procedures, but mortality at one month is 3.5%, similar to that of below knee amputations and 20% at one year. Any amputation is an indicator of poor health and should be considered a pivotal event in a patient's healthcare journey. In England alone, 21,738 minor lower limb amputations were performed between 2017 and 2020, with annual procedures on an increasing trajectory. Recent work has demonstrated striking regional differences in rates of major lower limb amputations in England which the authors ascribed to inequalities in the provision of healthcare. Improving the regional provision of support services for amputees is also part of the current governments NHS Long Term Workforce Plan (https://lordslibrary.parliament.uk/access-to-prosthetics-for-amputees-in-england/).
While multiple studies have aimed to assess the impact of anaesthetic technique on outcomes following major lower limb amputation, there is little published data on factors impacting morbidity and mortality following minor lower limb amputation surgery. Evidence from the USA has shown deleterious effect of general anaesthesia (GA) as compared to regional anaesthesia for minor lower limb amputation in patients with peripheral artery disease. Higher rates of post-operative wound disruption, pneumonia, prolonged intubation, and septic shock were demonstrated with general anaesthesia rather than regional anaesthesia.
Investigators have performed a single centre retrospective review of 382 patients undergoing minor lower limb amputation for vascular disease in our Trust (UHNM). We found that our patients undergoing these procedures under peripheral nerve block (PNB) techniques were older with higher rates of heart and kidney disease than those receiving a general anaesthetic. Despite this, these patients had reduced complications and length of hospital stay than the fitter patients. The difference seen here became even more pronounced following propensity matching. Investigators demonstrated a clinically significant reduction in the respiratory complication rate of 5.3% and overall complication rate of 12% and a reduction in length of stay of 6 days following use of peripheral nerve blocks rather than general anaesthesia. Investigators also demonstrated a reduction in length of stay of 4 days when DARF Form v4 - July 2023 16 administering peripheral nerve blocks rather than neuraxial anaesthesia (NA). This small and monocentric study suggests that there is value in repeating this process in a larger, national dataset.
- Conditions
- Anesthesia, Amputation; Traumatic, Leg, Lower
What is being measured
The primary outcome is the main question the study is designed to answer.
Morbidity following amputation
Compare all cause morbidity at 30 days following amputation under general, neuraxial and peripheral nerve block anaesthesia, converting it from local to national data
Measured: 30 days post amputation
Secondary outcomes (1)
Comparing emergency and elective outcomes
Comparing emergency and elective outcomes against American society of Anaesthesiologists (ASA) grading. ASA classification uses a grading system of I (one) through V (five), with I identifying a person in good health and V as a person with a severe, life-threatening condition. The sixth (VI) status identifies deceased organ donors.
Measured: 30 days post amputation
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted24 Nov 2025
- Study startJan 2026 (estimated)
- Primary completionNov 2026 (estimated)
- Study completionJan 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (7)Papers the sponsor has linked to this study.
- Other trials for AnesthesiaStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Retrospective
- Enrolment
- 300 participants (estimated)
Sponsor and investigators
- Lead sponsor
- University Hospitals of North Midlands NHS Trust
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07244627
- Sponsor's protocol ID
- 338872
- Acronym
- ATLLAS
- Status last verified
- Dec 2025
- First submitted
- 17 Nov 2025
- Last updated
- 4 Dec 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Publications
Yammine K, Hayek F, Assi C. A meta-analysis of mortality after minor amputation among patients with diabetes and/or peripheral vascular disease. J Vasc Surg. 2020 Dec;72(6):2197-2207. doi: 10.1016/j.jvs.2020.07.086. Epub 2020 Aug 21.
PubMed 32835790Ahmad N, Thomas GN, Gill P, Chan C, Torella F. Lower limb amputation in England: prevalence, regional variation and relationship with revascularisation, deprivation and risk factors. A retrospective review of hospital data. J R Soc Med. 2014 Dec;107(12):483-9. doi: 10.1177/0141076814557301. Epub 2014 Nov 11.
PubMed 25389229Chery J, Semaan E, Darji S, Briggs WT, Yarmush J, D'Ayala M. Impact of regional versus general anesthesia on the clinical outcomes of patients undergoing major lower extremity amputation. Ann Vasc Surg. 2014 Jul;28(5):1149-56. doi: 10.1016/j.avsg.2013.07.033. Epub 2013 Dec 14.
PubMed 24342828Waton S, Johal A, Birmpili P et al. National Vascular Registry: 2022 Annual Report. London: The Royal College of Surgeons of England, November 2022
Khan SA, Qianyi RL, Liu C, Ng EL, Fook-Chong S, Tan MG. Effect of anaesthetic technique on mortality following major lower extremity amputation: a propensity score-matched observational study. Anaesthesia. 2013 Jun;68(6):612-20. doi: 10.1111/anae.12182. Epub 2013 Apr 1.
PubMed 23550809Pisansky AJB, Brovman EY, Kuo C, Kaye AD, Urman RD. Perioperative Outcomes after Regional Versus General Anesthesia for Above the Knee Amputations. Ann Vasc Surg. 2018 Apr;48:53-66. doi: 10.1016/j.avsg.2017.10.014. Epub 2017 Dec 5.
PubMed 29217448Walsh M, Lim S, Gill L, et al. Deleterious Effects of General Anesthesia on Minor Foot Amputations. Abstract from the 2018 Midwestern Vascular Surgical Society Annual Meeting, Journal of Vascular Surgery 2018; 68: E54-55
Study at a glance
From the registry record, last updated by the sponsor on 4 Dec 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Anaesthetic Technique for Minor Lower Limb Amputation Surgery (ATLLAS): A Retrospective Review of Outcomes
- ClinicalTrials.gov ID
- NCT07244627
- Acronym / sponsor ID
- ATLLAS / 338872
- Conditions
- Anesthesia, Amputation; Traumatic, Leg, Lower
- Study type
- Observational
- Recruitment status
- Not yet recruiting
- Enrolment
- 300 participants (estimated)
- Lead sponsor
- University Hospitals of North Midlands NHS TrustUniversity, hospital or other
- Study start
- Jan 2026 (estimated)
- Primary completion
- Nov 2026 (estimated)
- Study completion
- Jan 2027 (estimated)
- First posted
- 24 Nov 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Major lower limb amputation is recognised as a significant cause of morbidity and mortality. In the United Kingdom, 30-day in-hospital mortality is up to 8.7%. Minor lower limb amputations, defined as amputation at or below the ankle, are often considered minor procedures, but mortality at one month is 3.5%, similar to that of below knee amputations and 20% at one year. Any amputation is an indicator of poor health and should be considered a pivotal event in a patient's healthcare journey. In England alone, 21,738 minor lower limb amputations were performed between 2017 and 2020, with annual procedures on an increasing trajectory. Recent work has demonstrated striking regional differences in rates of major lower limb amputations in England which the authors ascribed to inequalities in the provision of healthcare. Improving the regional provision of support services for amputees is also part of the current governments NHS Long Term Workforce Plan (https://lordslibrary.parliament.uk/access-to-prosthetics-for-amputees-in-england/).
While multiple studies have aimed to assess the impact of anaesthetic technique on outcomes following major lower limb amputation, there is little published data on factors impacting morbidity and mortality following minor lower limb amputation surgery. Evidence from the USA has shown deleterious effect of general anaesthesia (GA) as compared to regional anaesthesia for minor lower limb amputation in patients with peripheral artery disease. Higher rates of post-operative wound disruption, pneumonia, prolonged intubation, and septic shock were demonstrated with general anaesthesia rather than regional anaesthesia.
Investigators have performed a single centre retrospective review of 382 patients undergoing minor lower limb amputation for vascular disease in our Trust (UHNM). We found that our patients undergoing these procedures under peripheral nerve block (PNB) techniques were older with higher rates of heart and kidney disease than those receiving a general anaesthetic. Despite this, these patients had reduced complications and length of hospital stay than the fitter patients. The difference seen here became even more pronounced following propensity matching. Investigators demonstrated a clinically significant reduction in the respiratory complication rate of 5.3% and overall complication rate of 12% and a reduction in length of stay of 6 days following use of peripheral nerve blocks rather than general anaesthesia. Investigators also demonstrated a reduction in length of stay of 4 days when DARF Form v4 - July 2023 16 administering peripheral nerve blocks rather than neuraxial anaesthesia (NA). This small and monocentric study suggests that there is value in repeating this process in a larger, national dataset.
Study design
- Observational model
- Cohort
- Time perspective
- Retrospective
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
- Study population
- Patients in the National Vascular Registry (NVR) database for minor lower limb amputations undertaken between January 2019 and January 2025.
Key inclusion criteria (3 listed)
- Adult patients (aged 18 and over).
- National Vascular Registry data field - Procedure undertaken - amputation through ankle or below.
- Procedure undertaken between 1st January 2019 and 1st January 2025.
Key exclusion criteria (1 listed)
- Amputations due to trauma, neurological disease or chronic pain
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
Morbidity following amputation
Time frame: 30 days post amputation
Compare all cause morbidity at 30 days following amputation under general, neuraxial and peripheral nerve block anaesthesia, converting it from local to national data
1 secondary outcome
Comparing emergency and elective outcomes
Time frame: 30 days post amputation
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 4 Dec 2025.
- Background: PubMed 32835790Yammine K, Hayek F, Assi C. A meta-analysis of mortality after minor amputation among patients with diabetes and/or peripheral vascular disease. J Vasc Surg. 2020 Dec;72(6):2197-2207. doi: 10.1016/j.jvs.2020.07.086. Epub 2020 Aug 21.
- Background: PubMed 25389229Ahmad N, Thomas GN, Gill P, Chan C, Torella F. Lower limb amputation in England: prevalence, regional variation and relationship with revascularisation, deprivation and risk factors. A retrospective review of hospital data. J R Soc Med. 2014 Dec;107(12):483-9. doi: 10.1177/0141076814557301. Epub 2014 Nov 11.
- Background: PubMed 24342828Chery J, Semaan E, Darji S, Briggs WT, Yarmush J, D'Ayala M. Impact of regional versus general anesthesia on the clinical outcomes of patients undergoing major lower extremity amputation. Ann Vasc Surg. 2014 Jul;28(5):1149-56. doi: 10.1016/j.avsg.2013.07.033. Epub 2013 Dec 14.
- BackgroundWaton S, Johal A, Birmpili P et al. National Vascular Registry: 2022 Annual Report. London: The Royal College of Surgeons of England, November 2022
- Background: PubMed 23550809Khan SA, Qianyi RL, Liu C, Ng EL, Fook-Chong S, Tan MG. Effect of anaesthetic technique on mortality following major lower extremity amputation: a propensity score-matched observational study. Anaesthesia. 2013 Jun;68(6):612-20. doi: 10.1111/anae.12182. Epub 2013 Apr 1.
- Background: PubMed 29217448Pisansky AJB, Brovman EY, Kuo C, Kaye AD, Urman RD. Perioperative Outcomes after Regional Versus General Anesthesia for Above the Knee Amputations. Ann Vasc Surg. 2018 Apr;48:53-66. doi: 10.1016/j.avsg.2017.10.014. Epub 2017 Dec 5.
- BackgroundWalsh M, Lim S, Gill L, et al. Deleterious Effects of General Anesthesia on Minor Foot Amputations. Abstract from the 2018 Midwestern Vascular Surgical Society Annual Meeting, Journal of Vascular Surgery 2018; 68: E54-55
- Related InfoLink provided by the sponsor.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Anesthesia and Amputation; Traumatic, Leg, Lower, run by University Hospitals of North Midlands NHS Trust at 1 site in United Kingdom.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 4 Dec 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Aviva Ogbolosingha (01782 675380, aviva.ogbolosingha@uhnm.nhs.uk), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Morbidity following amputation (time frame: 30 days post amputation). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07244627, which also lists 7 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Dec 2025.