Open AccessProspective audit of major amputations for peripheral vascular disease
Author(s) -
Vallabhaneni S. R.,
Hughes D. M.,
Reilly D. T.,
Blair S. D.,
Greaney M. G.
Publication year - 2001
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1046/j.1365-2168.2001.01757-58.x
Subject(s) - medicine , amputation , prosthesis , surgery , perioperative , vascular disease , rehabilitation , prospective cohort study , mortality rate , physical therapy
Background: Primary amputation followed by prosthetic fitting has been proposed as an alternative worth considering if lower limb bypass has poor prospects of patency. This is an outcome audit of major amputations at a single centre where amputations were performed only if limb salvage was not possible. Methods: Consecutive major amputations ( n = 162) for peripheral vascular disease from January 1996 to December 1998 were studied prospectively. Duration of hospital stay, causes of morbidity and mortality, and reasons for being unsuitable for prosthesis were recorded. Mobility at admission and after rehabilitation was documented using a standard grading system (grades 1–6). Results: There were 114 above‐knee, 45 below‐knee and three through‐knee amputations. The 30‐day mortality rate was 14 per cent (22 patients), increasing to 29 per cent (47) at 9 months. Some 57 patients (35 per cent) were rehabilitated with a prosthetic limb (30 above knee, 27 below knee). Mobility with prosthesis was better or maintained in 24 patients, worse by one grade in 17, and by two or more grades in the remaining 16. Fifty‐eight patients (36 per cent) were unsuitable for an artificial limb; in four this was because of stump‐related problems, and the rest because of co‐morbidity. Cardiorespiratory events were the most frequent cause of morbidity and mortality. The mean hospital stay after amputation was 37 days in survivors. Conclusion: Perioperative and late mortality rates following amputation are high. A large proportion of amputees were not suitable for prosthesis, mainly because of co‐morbidity. Of the patients receiving a prosthesis, only 42 per cent (15 per cent of the total) maintained or improved their mobility. The results are unlikely to be different if a policy of selective primary amputation were to be adopted. The outcome of amputation is worse than widely perceived despite the improvements in prostheses and a well executed rehabilitation process. © 2001 British Journal of Surgery Society Ltd