Major Lower Limb Amputation: Outcomes are Improving

Kelly, David A.; Pedersen, Stephanie; Tosenovsky, Patrik; Sieunarine, Kishore

doi:10.1016/j.avsg.2017.05.039

Cited by 29 publications

(31 citation statements)

References 16 publications

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“…The male predominance of 61.4% in our sample is consistent with other reports [8, 9, 11, 15, 16, 25, 27–29]. 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].…”

Section: Discussionsupporting

confidence: 90%

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

et al. 2019

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BackgroundWe aimed to explore the surgical outcomes of major lower extremity amputation (MLEA) and influencing factors at an academic tertiary referral centre in north Jordan, optimistically providing a platform for future health care policies and initiatives to improve the outcomes of MLEA in Jordan.MethodsClinical records of patients who had undergone MLEA between January 2012 and December 2017 were identified and retrospectively reviewed. International Classification of Diseases codes were used to identify the study cohort from a prospectively maintained computerised database. We included adult patients of both genders who underwent amputations for ischemic lower limb (acute and chronic) and diabetic foot syndrome (DFS). We excluded patients for whom MLEA surgery was performed for other indications (trauma and tumors). Outcomes of interest included patient demographics and comorbidities, type of amputation and indications, length of hospital stay (LOS), the need for revision surgery (ipsilateral conversion to a higher level of amputation), and cumulative mortality rate at 1 year. The impact of the operating surgeon’s specialty (vascular vs. non-vascular surgeon) on outcomes was evaluated.ResultsThe study cohort comprised 140 patients who underwent MLEA (110 below-knee amputations [BKA] and 30 above-knee amputations [AKA]; ratio: 3:1; 86 men; 54 women; mean age, 62.9 ± 1.1 years). Comorbidities included diabetes, hypertension, dyslipidaemia, ischaemic heart disease, congestive heart failure, chronic kidney disease, stroke, and Buerger disease. The only associated comorbidity was chronic kidney disease, which was more prevalent among BKA patients (p = 0.047). Indications for MLEA included DFS, and lower limb ischaemia. Acute limb ischaemia was more likely to be an indication for AKA (p = 0.006). LOS was considerably longer for AKA (p = 0.035). The cumulative mortality rate at 1 year was 30.7%. Revision surgery rates and LOS improved significantly with increased rate of vascular surgeon-led MLEA.ConclusionsIn developing countries, the adverse impact of MLEA is increased because of limited resources and increased prevalence of diabetes-related foot complications. Vascular surgeon-led MLEA is associated with decreased revision rates, LOS and possibly improved outcomes, particularly when it is performed for vascular insufficiency. It is important to formulate national health care policies to improve patient outcomes in these countries.

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Section: Discussionsupporting

confidence: 90%

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

et al. 2019

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“…62,63 The time course of physical activity recovery for patients with nontraumatic LLA is unique, as they require extended recovery times compared to patients with LLA from other etiologies, due to vascular and medical comorbidity. 64 Previous studies in nontraumatic LLA have found accelerometer-based average daily step counts to be very low, 9,11 equating to less than one-third of the recommended daily steps for people with disabilities. 59 For example, average daily steps for people within the first 6 months after LLA have been measured at 1721 (1524) steps/d [mean(SD)].…”

Section: Discussionmentioning

confidence: 97%

Biobehavioral Intervention Targeting Physical Activity Behavior Change for Older Veterans after Nontraumatic Amputation: A Randomized Controlled Trial

Christiansen

Miller

Kline

et al. 2020

PM&R

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Background: Lower-limb amputation (LLA) due to non-traumatic vascular etiology is linked to extremely low physical activity and high disability. Objective: To test the feasibility of a biobehavioral intervention designed to promote physical activity. Design: A randomized, single-blind feasibility trial with a crossover design. Setting: Veterans Administration Medical Center. Participants: Military veterans (age: 65.7 [7.8] years; mean [standard deviation]) with nontraumatic lower-limb amputation (LLA), randomized to two groups: GROUP1 (n = 16) and GROUP2 (n = 15). Both groups had similar baseline amputation characteristics (level of amputation and time since amputation). Interventions: Twelve weekly, 30-minute telehealth sessions of physical activity behavior-change intervention, with GROUP1 participating in weeks 1-12 and GROUP2 in weeks 13-24. GROUP1 noncontact phase in weeks 13-24 and GROUP2 attention control telehealth phase in weeks 1-12. Main Outcome Measures: Feasibility (participant retention, dose goal attainment, intervention acceptability [Intrinsic Motivation Inventory [IMI] Interest and Enjoyment scale], safety) and signal of efficacy (free-living physical activity [accelerometer-based average daily step count], Late Life Function and Disability Index-Disability Scale [LLFDI-DS]). Results: Participant retention rate was high (90%), with three participants lost to follow-up during the intervention period. Dose goal attainment was low, with only 10% of participants achieving an a priori walking dose goal. Intervention was rated as acceptable, with mean IMI Interest and Enjoyment score (5.8) statistically higher than the null value of 5.0 (P = .002). There were no between-group differences in adverse event rates (falls: P = .19, lower extremity wounds: P = .60). There was no signal of efficacy for change in average daily step count (d = −0.15) or LLFDI-DS (d = −0.22 and 0.17 for frequency and limitations scales, respectively). Conclusions: Telehealth delivered biobehavioral intervention resulted in acceptable participant retention, low dose goal attainment, high participant acceptability, and low safety risk, while having no signal of efficacy (physical activity, disability) for people with nontraumatic LLA.

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“…Therefore, reducing the incidence of major LEA is a major health priority and considered a core indicator of the long-term quality of diabetes care worldwide [12]. Data from national audits in many countries and the Organization for Economic Cooperation and Development (OECD) have demonstrated a significant decline in the incidence of diabetes-related major LEA over years owing to DFU prevention and care programs [11][12][13][14]. Nevertheless, studies have reported up to a 20-fold variation in the rate of major LEA among countries [15,16].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of major lower extremity amputations in individuals with diabetes in Austria, 2014–2017: A retrospective analysis of health insurance database

Aziz

Reichardt

Sourij

et al. 2020

Diabetes Research and Clinical Practice

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To describe the incidence, mortality, and trend of major lower extremity amputations (LEA) and to assess risk factors of all-cause mortality after major LEA in individuals with diabetes. Methods: Procedure codes of major LEA were extracted from the Austrian Health Insurance database (N = 507,180) during 2014-2017 to estimate crude and age-standardized rates per 100,000 population. Short-(30-day, 90-day) and long-term (1-year, 5-year) all-cause mortality after major LEA was estimated from the date of amputation till the date of death. Results: The age-standardized rate of major LEA was 6.44 with an insignificant annual change of 3% (p = 0.825) from 2014 to 2017. Cumulative 30-day mortality was 13.5%, 90-day 22.0%, 1-year 34.4%, and 5-year 66.7%. Age, male sex, above-knee amputation, Charlson index, and heart failure were significantly associated with both short-and long-term mortality. Cancer, dementia, heart failure, peripheral vascular disease, and renal disease were associated with long-term mortality. Conclusions: The rate of major LEA in individuals with diabetes remained stable during 2014-2017 in Austria. Short-and long-term mortality rates were considerably high after major LEA. Old age, male sex, above-knee amputations, and Charlson Index were significant predictors of both short-and long-term mortality and comorbidities were significant predictors of long-term mortality only.

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Major Lower Limb Amputation: Outcomes are Improving

Cited by 29 publications

References 16 publications

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

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

Biobehavioral Intervention Targeting Physical Activity Behavior Change for Older Veterans after Nontraumatic Amputation: A Randomized Controlled Trial

Epidemiology of major lower extremity amputations in individuals with diabetes in Austria, 2014–2017: A retrospective analysis of health insurance database

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