Development of Core Outcome Sets for Patients Undergoing Major Lower Limb Amputation for Complications of Peripheral Vascular Disease

Abstract

source population for this study comprised almost 1 million individuals. Results: Between 2010-2014, we identified 3.677newly diagnosed PAD patients. Most patients (91%) were diagnosed in primary care, and in primary care at the end of the study (83%). Almost half of all patients (49%) had no APT dispensing record. Within this group, 33% received other anticoagulant therapy (vit.-k antagonist or DOAC). Mono-APT was dispensed as aspirin (40% of patients) or P2Y12inhibitors (2.5% of patients). Dual-APT (DAPT) combining aspirin with a P2Y12-inhibitor was dispensed to 8,5% of the study population. Conclusion: Half of all patients with newly diagnosed PAD are not treated conform (international) guideline recommendations on thromboembolism prevention through APT. At least 33% of all patients with newly diagnosed PAD do not receive any antithrombotic therapy.Evaluation and improvement of APT prescription and thereby improved prevention of (secondary) cardiovascular events is warranted. We advise all physicians to inquire if PAD patients receive APT and if not, to investigate if there is a valid reason to omit prescribing these medicines.

Systematic Review and Meta-Analysis of the Effect of Perineural Catheters in Major Lower Limb Amputations

“…Demographic data extracted were: first author, year of study, study type (randomised control trials, cohort, case controlled or quasi-experimental) and design (including whether retrospective or prospective, single or multiple centres, and if consecutive patients were enrolled), number of patients, primary anaesthetic given to both intervention and control groups, local anaesthetic type used in the treatment group, and study quality as assessed using the Downs and Black (D&B) score. 14 Based on the recently published core outcome sets for patients undergoing MLLA from a Delphi consensus process, 6 the following outcomes were selected:…”

“…1 Ambler et al recently published core outcome sets based on a Delphi consensus process for patients undergoing MLLA and highlighted the significance of reporting acute post-surgical pain, residual stump pain, and PLP in future studies. 6 Adequate pain control using a multimodal approach is therefore high on the agenda for vascular surgeons and anaesthetists to minimise the significant negative impact on amputees' quality of life, rehabilitation, psychosocial wellbeing and return to employment. 7e11 In 2015, the present study group performed a systematic review and meta-analysis of seven studies (416 patients), which highlighted the benefit of surgically inserted perineural catheters (PNC) in reducing post-operative opioid consumption.…”