SwedeAmp—the Swedish Amputation and Prosthetics Registry: 8-year data on 5762 patients with lower limb amputation show sex differences in amputation level and in patient-reported outcome

Abstract

Background and purpose — For want of national guidelines for lower limb amputation (LLA) the quality registry SwedeAmp was started in 2011 to increase knowledge around LLA and prosthetic rehabilitation. We now present data from the first 8 years of registration. Patients and methods — We present descriptive data from the first 8 years (2011–2018) of registration. Patient-reported outcome was collected at baseline and at follow-up 12 and 24 months after surgery for patients with prosthetic supply and included generic (EQ-5D-5L) and amputee-specific (e.g., LCI-5L and Prosthetic Use Score) measures. Sex differences were investigated. Results — As at December 31, 2018, 5,762 patients, 7,776 amputations, 2,658 prosthetic supplies, 1,848 baselines, and 2,006 follow-ups were registered. 61% of the patients were male, and mean age by the time of the first registered amputation was 74 years (SD 14). Women were older, more frequently had vascular disease without diabetes and more often underwent amputation at a higher level compared with men (p < 0.001). Time from amputation to fitting of first individual prosthesis was median 69 days (6–500) after transtibial amputation (TTA) and 97 days (19–484) after transfemoral amputation (TFA). The outcomes were lower after TFA than after TTA. Interpretation — SwedeAmp shows sex differences concerning amputation level, diagnosis, and age, leading to the conclusion that women have worse preconditions for successful prosthetic mobility after LLA. With increasing coverage, SwedeAmp can provide deeper knowledge with regard to patients undergoing LLA in Sweden.

A Caribbean perspective: Quality of Life in Major Lower Extremity Amputees

“…The 30-day mortality rate observed for this cohort of patients was 14%, which doubled to 27% at 1 -year. These rates are comparable to those from Sweden, New Zealand study as well as several other regions [19,34,35]. Moreover, the hospital mortality rate of 9% was marginally lower to that published by Solomon et al in a locally conducted study [1].…”

“…Admittedly, many of the countries for which the average overall index values were compared to are of the rst-world status, with superior health care systems. This cohort had a higher overall index value when compared to Scottish, Swedish and Chinese data [19][20][21]. Although many of these studies have used the EQ 5D-5L or 3L Quality of life assessment tools, there is a variation of the time elapsed post amputation and when the assessment was performed.…”

Inter-limb weight transfer strategy during walking after unilateral transfemoral amputation

“…In turn, higher mobility has been linked to improved satisfaction and quality of life in patients after major lower limb amputation 3 , 6 , 7 , making mobility restoration a priority in prosthetic gait training for individuals with lower limb amputation. A recent study highlighted the importance of adequate prosthetic gait rehabilitation for patients with major lower limb amputation to regaining mobility 8 . Therefore, the quantification and evaluation of gait biomechanics in individuals with lower limb amputation is essential for delivering objective, targeted improvements in rehabilitation strategies and prosthetic design to maximize long-term mobility outcomes.…”

From outcome measurement to improving health outcomes following lower limb amputation - making outcome measurement work from a clinical practice perspective

“…The first is the Scottish Physiotherapy Amputee Research Group (SPARG) which collects data on all patients undergoing amputation in Scotland, 72 and the second is SwedeAmp, the national lower limb amputation quality registry from Sweden. 73 Both registries attempt to evaluate the whole medical process concerning lower limb amputation collecting demographic details, surgical and rehabilitation interventions, prosthetic supply and outcome. For SwedeAmp, uptake across the country has been slow and after 9 years the registry captures 62% of amputations, 73 illustrating again the challenges related to system level data collection.…”

“…73 Both registries attempt to evaluate the whole medical process concerning lower limb amputation collecting demographic details, surgical and rehabilitation interventions, prosthetic supply and outcome. For SwedeAmp, uptake across the country has been slow and after 9 years the registry captures 62% of amputations, 73 illustrating again the challenges related to system level data collection. Despite these challenges huge amounts of data are now available for analysis and these projects demonstrate what is possible.…”