The patient's experience of amputation due to peripheral arterial disease

Torbjörnsson, Eva; Ottosson, Carin; Blomgren, Lena; Boström, Lars; Fagerdahl, Ann-Mari

doi:10.1016/j.jvn.2016.11.002

Cited by 23 publications

(13 citation statements)

References 18 publications

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“…Individuals with PAD have reduced quality of life ( 5 , 6 ) and increased risk for functional limitation ( 7 , 8 ), cardiovascular disease ( 9 , 10 ), and mortality ( 11 , 12 ). Major limb amputation is a serious complication of PAD that arises when significant tissue loss has occurred, when medical or surgical intervention is not possible, or when an intervention has been unsuccessful ( 13 , 14 ). Some amputations are medically necessary, usually in individuals with PAD who have chronic limb threatening ischemia.…”

Section: Introductionmentioning

confidence: 99%

The association between socioeconomic distress communities index and amputation among patients with peripheral artery disease

Witrick¹,

Shi

Mayo

et al. 2022

Front. Cardiovasc. Med.

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BackgroundSocioeconomic factors have been shown to be associated with amputation in peripheral artery disease (PAD); however, analyses have normally focused on insurance status, race, or median income. We sought to determine whether community-level socioeconomic distress was associated with major amputation and if that association differed by race.Materials and methodsCommunity-level socioeconomic distress was measured using the distressed communities index (DCI). The DCI is a zip code level compositive socioeconomic score (0–100) that accounts for unemployment, education level, poverty rate, median income, business growth, and housing vacancies. A distressed community was defined as a zip code with DCI of 40 or greater. We calculated one-year risk of major amputation by DCI score for individuals with peripheral artery disease in South Carolina, 2012–2017. Treating death as competing event, we reported Fine and Gray subdistribution hazards ratios (sdHR), adjusted for patient demographic and clinical comorbidities associated with amputation. Further analyses were completed to identify potential differences in outcomes within strata of race and DCI.ResultsAmong 82,848 individuals with peripheral artery disease, the one-year incidence of amputation was 3.5% (95% CI: 3.3%, 3.6%) and was significantly greater in distressed communities than non-distressed communities (3.9%; 95% CI: 3.8%, 4.1% vs. 2.4%; 95% CI: 2.2%, 2.6%). After controlling for death and adjusting for covariates, we found an increased hazard of amputation among individuals in a distressed community (sdHR: 1.25; 95% CI: 1.14, 1.37), which persisted across racial strata. However, regardless of DCI score, Black individuals had the highest incidence of amputation.ConclusionSocioeconomic status is independently predictive of limb amputation after controlling for demographic characteristics and clinical comorbidities. Race continues to be an important risk factor, with Black individuals having higher incidence of amputation, even in non-distressed communities, than White individuals had in distressed communities.

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Section: Introductionmentioning

confidence: 99%

The association between socioeconomic distress communities index and amputation among patients with peripheral artery disease

Witrick¹,

Shi

Mayo

et al. 2022

Front. Cardiovasc. Med.

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“…These results are congruent with our findings of an out of control or creeping decay of the flesh, and relentless pain during the lead‐in (preoperative) period of complex wounds requiring regular analgesia and dressing routines, and repeated attempts to revascularise limbs. Relentless pain and its impact on activities of daily living during the lead‐in to amputation of months to years were echoed in the description of Rassin, Tzevlin, Malul, Harel, and Shakhar () as “a trail of torment.” Several studies (Chini & Boemer, ; Liu, Williams, Liu, & Chien, ; Rassin et al, ; Torbjörnsson, Ottosson, Blomgren, Boström, & Fagerdahl, ) also described the pain of CLTI as involving “suffering” and several reported subsequent problems with sleep (Rassin et al, ; Torbjörnsson et al, ). Mohler and Schnepp () and Rassin et al () addressed the variable length and intensity of health deterioration as amputation approached.…”

Section: Discussionmentioning

confidence: 99%

“…Relentless pain and its impact on activities of daily living during the lead-in to amputation of months to years were echoed in the description of Rassin, Tzevlin, Malul, Harel, and Shakhar (2012) as "a trail of torment." Several studies (Chini & Boemer, 2007;Liu, Williams, Liu, & Chien, 2010;Rassin et al, 2012;Torbjörnsson, Ottosson, Blomgren, Boström, & Fagerdahl, 2017) also described the pain of CLTI as involving "suffering" and several reported subsequent problems with sleep (Rassin et al, 2012;Torbjörnsson et al, 2017). Mohler and Schnepp (2010) and Rassin et al (2012) addressed the variable length and intensity of health deterioration as amputation approached.…”

Section: Discussionmentioning

confidence: 99%

The body with chronic limb‐threatening ischaemia: A phenomenologically derived understanding

Monaro

West

Gullick

2020

Journal of Clinical Nursing

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Aims and Objectives To explore person and family lifeworld narratives of chronic limb‐threatening ischaemia (CLTI) after major amputation has been offered as a treatment option. Background Chronic limb‐threatening ischaemia manifests as ischaemic pain, ulceration and/or gangrene and is receiving heightened attention due to the increasing health system burden from associated complex wounds and hospitalisations for repeat procedures. The patient and family impact of these manifestations is not well‐reported: current studies largely seek to measure treatment outcomes. Patient‐reported outcome measurements need to be developed but should be underpinned by rigorous qualitative research. Design Prospective, longitudinal, qualitative design using interpretive phenomenology. Methods The journeys of 19 people with CLTI were explored via 42 semi‐structured interviews with 14 patient and 13 family participants. The initial interview was conducted soon after the advice of the need for major amputation, and where amputation followed, participants were invited for a second interview 6 months postprocedure. Hermeneutic phenomenological analysis was guided by Merleau‐Ponty's philosophy of embodiment. Results People with embodied CTLI faced an existential crisis due to the catastrophic impact of creeping decay of their flesh and vascular system, relentless pain and a sense of spreading poison from gangrene, infection and drugs, which disrupted the interleaving of the physical and existential body. Consequent to the creeping decay and surgery, participants also experienced shifting body boundaries and an unreliable body. Conclusions The lifeworld of the patient and family living with CTLI is irrevocably altered through the disruption of a spontaneous and reliable body. This shapes subsequent therapeutic relationships and discourse. Relevance to Clinical Practice People facing CLTI require early patient‐ and family‐centred discussions about the possibility for major amputation and its potential to arrest the further decline of the body and to support the body's existential expression.

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“…Peripheral artery disease (PAD) is a progressive circulatory systems disorder that occurs when there is an obstruction of the peripheral arteries outside of the heart and thoracic aorta that limit the flow of oxygen-rich blood to parts of the body, particularly the lower extremities [ 1 ]. PAD can lead to poor quality of life [ 2 ] and increased risk of negative outcomes, such as amputation [ 3 , 4 , 5 , 6 , 7 ] or premature death [ 8 , 9 ]. Current estimates indicate that 5% of the global population are affected by PAD, with the prevalence increasing up to 29% in high-risk individuals who are advanced in age and have additional comorbidities [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Geographic Disparities in Readmissions for Peripheral Artery Disease in South Carolina

Witrick

Kalbaugh

Shi

et al. 2021

IJERPH

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Readmissions constitute a major health care burden among peripheral artery disease (PAD) patients. This study aimed to 1) estimate the zip code tabulation area (ZCTA)-level prevalence of readmission among PAD patients and characterize the effect of covariates on readmissions; and (2) identify hotspots of PAD based on estimated prevalence of readmission. Thirty-day readmissions among PAD patients were identified from the South Carolina Revenue and Fiscal Affairs Office All Payers Database (2010–2018). Bayesian spatial hierarchical modeling was conducted to identify areas of high risk, while controlling for confounders. We mapped the estimated readmission rates and identified hotspots using local Getis Ord (G*) statistics. Of the 232,731 individuals admitted to a hospital or outpatient surgery facility with PAD diagnosis, 30,366 (13.1%) experienced an unplanned readmission to a hospital within 30 days. Fitted readmission rates ranged from 35.3 per 1000 patients to 370.7 per 1000 patients and the risk of having a readmission was significantly associated with the percentage of patients who are 65 and older (0.992, 95%CI: 0.985–0.999), have Medicare insurance (1.013, 1.005–1.020), and have hypertension (1.014, 1.005–1.023). Geographic analysis found significant variation in readmission rates across the state and identified priority areas for targeted interventions to reduce readmissions.

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The patient's experience of amputation due to peripheral arterial disease

Cited by 23 publications

References 18 publications

The association between socioeconomic distress communities index and amputation among patients with peripheral artery disease

The association between socioeconomic distress communities index and amputation among patients with peripheral artery disease

The body with chronic limb‐threatening ischaemia: A phenomenologically derived understanding

Geographic Disparities in Readmissions for Peripheral Artery Disease in South Carolina

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