Prevalence and pattern of major extremity amputation in a tertiary Hospital in Nnewi, South East Nigeria

Ndukwu, Chibuzo U; Muoneme, Chigozie A

doi:10.4103/1119-0388.158405

Cited by 15 publications

(14 citation statements)

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“…Many authors have reported sepsis as the underlying cause of death in their series. [25][26][27] This is similar to our findings as two diabetic and two traumatic amputees died from sepsis related complications with persistent fever, copious purulent wound discharges and eventually septic shock and death. One diabetic developed renal failure 4 weeks post-amputation, and he was referred to dialysis clinic but a return referral confirmed he died after one session of dialysis.…”

Section: Discussionsupporting

confidence: 93%

The indications for major limb amputations: 8 years retrospective study in a private orthopaedic and trauma centre in the south-east Nigeria

Agu

Ojiaku

2016

Journal of Clinical Orthopaedics and Trauma

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Section: Discussionsupporting

confidence: 93%

The indications for major limb amputations: 8 years retrospective study in a private orthopaedic and trauma centre in the south-east Nigeria

Agu

Ojiaku

2016

Journal of Clinical Orthopaedics and Trauma

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“…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].…”

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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“…The increasing numbers of patients with diabetes could be the contributing factor to the high number of LLAs at Addington Hospital. This is in keeping with the 2015 study by Ndukwu and Muoneme, 8 who found that below-knee and trans-tibial amputations comprised 64.4% of LLAs, and Kayssi et al, 9 who reported that 60-70% of BKAs were performed as a result of PVD or circulatory complications. These results also concur with findings from Odatuwa-Omagbemi, 10 who noted that 63.6% of non-traumatic LLAs were due to diabetic foot complications.…”

Section: Discussionsupporting

confidence: 86%

“…7 In 54% of Americans living with limb loss the cause is vascular disease whereas in Sri Lanka 4.8% of amputations are due to diabetes and in South East Nigeria 71.4% of all amputations are attributed to diabetes. [6][7][8] Furthermore the most common level of amputation appears to be below-knee amputation (BKA) (63.7%). [6][7][8] Addington Hospital is a regional South African hospital located in the eThekwini municipality and is a referral hospital for patients requiring major surgical intervention such as amputations.…”

Section: Introductionmentioning

confidence: 99%

“…[6][7][8] Furthermore the most common level of amputation appears to be below-knee amputation (BKA) (63.7%). [6][7][8] Addington Hospital is a regional South African hospital located in the eThekwini municipality and is a referral hospital for patients requiring major surgical intervention such as amputations. A study on the prevalence and management of the diabetic foot at Addington Hospital has not been previously conducted.…”

Section: Introductionmentioning

confidence: 99%

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A five-year audit of lower limb amputations below the knee and rehabilitation outcomes: the Durban experience

Manickum

Ramklass

Madiba

2019

Journal of Endocrinology, Metabolism and Diabetes of South Afri

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Lower limb amputation (LLA) due to diabetes mellitus (DM) is a growing epidemic worldwide. Objectives: To determine the prevalence of LLAs at Addington Hospital from 2010 to 2014 and to explore the rehabilitation outcomes of amputees. Design and setting: A retrospective chart review of LLAs below the knee was undertaken at Addington Hospital. Subjects: Patients who underwent LLAs were filtered from theatre registers. Methodology: A data collection sheet included demographic profile, diabetic status, level of amputation, limb orientation and rehabilitation outcomes. Outcome measures: Study endpoints were prevalence, compliance and rehabilitation outcomes. Results: From 2010 to 2014, 767 LLAs in 667 patients were identified. Mean age was 59 (13.2) years. M:F ratio was 1:1. Of these, 354 patients (53.1%) had DM. Level of amputation was below-knee 57%, trans-metatarsal 12.4% and toectomy 30.6%. Only 116 patients (17.4%) were referred for physiotherapy, of whom 95 (81.9%) attended. Median frequency of physiotherapy visits was five and four for diabetic and non-diabetic amputees respectively. Mobility after rehabilitation was with a walking frame (49%), crutches (32%), prosthesis and crutches (8%), wheelchair-bound (9%) and independent gait (1%). Conclusion: Over half of amputations were associated with DM. The gender incidence was similar. Referral to physiotherapy and adherence thereto was poor.

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Prevalence and pattern of major extremity amputation in a tertiary Hospital in Nnewi, South East Nigeria

Cited by 15 publications

References 0 publications

The indications for major limb amputations: 8 years retrospective study in a private orthopaedic and trauma centre in the south-east Nigeria

The indications for major limb amputations: 8 years retrospective study in a private orthopaedic and trauma centre in the south-east Nigeria

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

A five-year audit of lower limb amputations below the knee and rehabilitation outcomes: the Durban experience

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