Epidemiology of major limb amputations: a cross sectional study from a South Indian tertiary care hospital

Abstract

Background: Limb loss to amputation is a major problem especially in developing countries where majority of the cases are preventable. It is a burden, not just for the patient, but also for their care givers which imposes tremendous financial and psychological burden upon them. The aim was to outline the patterns, indications and short term complications of major limb among patients attending Government Medical College, Kozhikode, Kerala, India which is a tertiary care centre.Methods: This was a prospective, observational study that was conducted at Govt. Medical College, Kozhikode, for a period of 18 months. 81 patients underwent major limb amputations in our hospital during the study period.Results: The age ranged between 23 to 90 years (mean 59.23±14.79). Males outnumber females by a ratio of 4:1. Above knee (transtibial) amputations were the most common. Diabetes mellitus was the most common cause (39.5%) followed by chronic NDMVI (33.3%). Younger individuals who underwent amputation were mostly due to trauma. Most common post op complication was surgical site infection (21%) and the most common organism cultured from the wound was Pseudomonas (50%). The most common additional procedure done was wound debridement. Themortality rate was 10% and mean duration of hospital stay was 23 days. Conclusions: Complications of diabetic foot ulcers and chronic vascular disease were the most common indications for major limb amputation in our environment. Trauma was the most common indication in younger individuals. The majority of these amputations are preventable by provision of health education, early presentation and appropriate management of the common indications.

Major lower extremity amputation: a contemporary analysis from an academic tertiary referral centre in a developing community

“…The ipsilateral revision rate of BKA to AKA in our study 10.0%) was in accordance with revision rates reported by Aulivola et al and Dillingham et al [7, 12] However, our revision rates were lower than those reported by Cruz et al (12%) and Lim et al (17.6%) [10, 15], and higher than those reported by Unnikrishnan et al [18] The immense disparity in the revision rates reported in the literature may be due to poor primary assessment of the amputation level by training residents, poor management of the amputation stump, and the high risk of falls for this frail patient cohort, all of which may lead to stump dehiscence. Our favourable revision rates might be explained by the increased number of surgeries performed by vascular surgeons over the past 6 years, with 90.0% of MLEA procedures performed by vascular surgeons in 2017 compared to 21.4% in 2012.…”

“…Furthermore, there is a wide variation in the reported indications for MLEA. Unlike developed countries, where peripheral arterial disease remains the most common indication for MLEA [14–17], in our series, DFS was the leading indication for MLEA, and this was consistent with other reports from developing nations [18–22]. This is not surprising given that diabetes leads to peripheral arterial disease and three-quarters of MLEA procedures are performed for diabetic patients [11].…”

“…The mean age of the population in this study was 62.9 years, which is relatively younger than that of other study populations in the literature [8–11, 15, 17, 27, 30, 31]. However, it is comparable with that presented in studies performed in developing countries [18, 19, 22, 32]. This observation can be explained by the fact that diabetes is known to increase the risk of amputation at a younger age, especially when it is acquired at a young age and the vast majority of our patients had diabetes and its related complications [11, 12, 31, 33].…”

Major limb loss (MLL): an overview of etiology, outcomes, experiences and challenges faced by amputees and service providers in the post-conflict period in Northern Uganda

“…21 The emergence of non-communicable diseases (NCDs) such as peripheral vascular disease, diabetes and leg gangrene as causes for major limb loss is in keeping with the increasing importance of NCDs in the overall disease burden in Sub Saharan Africa. The mortality rate after major amputation was 9.9% in our study and compares with the findings of Unnikrishnan et al 22 The incidence of stump infection after amputation surgery in Africa has been reported to be between 13 -77% depending on the choice of peri-operative prophylactic antibiotic use. 23 We did not have data on the antibiotics used in our patients, but the infection rate in our cohort (12.8%) compares very well with data from South Africa in patients in whom amoxicillin and clavulanic acid was used in combination for prophylaxis.…”

A Demographic Study of Lower Limb Amputees in a North Indian Tertiary Rehabilitation Center

“…3 In a service dedicated for diabetic foot and vascular diseases, 81 planned amputations were performed in one and a half year in a center in Kozhikode. 4 After studying the causes of amputation in young men from Illinois, USA, Lambert and Sciora 5 found that trauma was the most common, accounting for 52% of all amputations. Later, Warren and Kihn 6 reported that 76% of 1,964 amputees who received treatment at the Veterans Administration Hospital had undergone amputation because of vascular insufficiency.…”