Racial and Ethnic Amputation Level Disparities in Veterans Undergoing Incident Dysvascular Lower Extremity Amputation

PM&R ◽  
2021 ◽  
Author(s):  
Max Hurwitz ◽  
Daniel C. Norvell ◽  
Joseph M. Czerniecki
Keyword(s):  
Lower Extremity ◽  
Lower Extremity Amputation ◽  
Amputation Level ◽  
Extremity Amputation

scholarly journals Dismounted complex blast injuries

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Paul Ryan ◽  
Claude Anderson ◽  
Steven Wilding
Keyword(s):  
Lower Extremity ◽  
Upper Extremity ◽  
The United States ◽  
Lower Extremity Amputation ◽  
Traumatic Amputation ◽  
Amputation Level ◽  
Skeletal Injury ◽  
Knee Amputation ◽  
The Us ◽  
Extremity Amputation

Category: Trauma Introduction/Purpose: The United States Medical Corps has continued to evaluate and define the injury patterns of our service members in an effort to prevent injury and improve combat casualty care. The pattern of injury can be predicted by the mechanism of injury. One of the more recently described and studied mechanisms has been coined the ‘dismounted complex blast injury. This injury pattern involves traumatic amputation of at least one leg with a second injury involving another extremity in addition to an injury to either the pelvis, the abdomen, or the urogenital region. The purpose of this study was to better define and describe the injuries occurring to the non amputated extremity. Methods: This is a retrospectively review of data from the US and UK Joint Theater Trauma Registries (JTTR) of consecutive patients admitted to the UK Role 3 hospital at Camp Bastion, Afghanistan, from January 1, 2009, to February 29, 2012. Data was obtained from the US JTTR (Joint Theatre Trauma Registry). Each patient was assigned an Injury Severity Score (ISS) and an Abbreviated Injury Scale (AIS) score. Only those patients with an AIS of 3 or greater (a serious injury) were included. All xrays and CT scans were evaluated by two board certified orthopaedic surgeons and one board certified musculoskeletal radiologist. Fisher’s exact test was used to compare categorical data and binomial logistic regression was be used to compare proportions of types of injuries by traumatic amputation level observed. Results: There were 295 patients with lower extremity injuries identified. 201 had traumatic lower extremity amputations, 140 with bilateral lower extremity amputations, 61 with single leg amputations. The mean age was 23.38 +/-3.77 years. All were male. Below the knee amputation was the most frequent amputation type observed, representing 55.7% of the amputations (29/52), the next most frequent was the through knee amputation representing 25%. The least frequent was the through ankle amputation. The presence of a symes level amputation was associated with an 8.1% increase in the odds of the presence of a skeletal foot injury in the rear lower extremity. There was also an association found between AKA level amputation and skeletal injury in the contralateral upper extremity . Conclusion: This is among the first studies to correlate level of injury and associated musculoskeletal injury for the Afghanistan theater of operations. The results of this data set demonstrate that proximal lower extremity amputation levels are significantly associated with distal upper extremity skeletal injury. In addition, the Symes level of amputation is significantly associated with contralateral foot fractures. Amputation levels proximal to the ankle often present with associated Genitourinary injuries. Unique to this study is the demonstration of a significant association of upper extremity injury with a more proximal lower extremity amputation level .

Amputation and reamputation of the diabetic foot

1997 ◽  
Vol 87 (6) ◽  
pp. 255-259 ◽  
Author(s):  
DG Armstrong ◽  
LA Lavery ◽  
LB Harkless ◽  
WH Van Houtum
Keyword(s):  
Lower Extremity ◽  
Previous History ◽  
Arterial Disease ◽  
Lower Extremity Amputation ◽  
South Texas ◽  
Diabetic Patients ◽  
Amputation Level ◽  
Causal Pathway ◽  
Peripheral Arterial ◽  
Extremity Amputation

The authors compare the level of foot amputation by age, prevalence of arterial disease as a precipitating factor, gender, and ethnicity in persons with diabetes mellitus. Medical records were abstracted for each hospitalization for a lower extremity amputation from January 1 to December 31, 1993, in six metropolitan statistical areas in south Texas. Amputation level was defined by ICD-9-CM codes and were categorized as foot, leg, and thigh amputations. Foot-level amputations were further subcategorized as hallux or first ray, middle, fifth, multiple digit or ray, and midfoot amputations. Only the highest amputation level for each individual was used in the analysis. Of 1,043 subjects undergoing a lower extremity amputation in south Texas in the year 1993, 477 received their amputation at the level of the foot. African-Americans requiring a foot-level amputation were at significantly higher risk to undergo a midfoot-level amputation than was the rest of the population. Nearly 40% of all subjects undergoing a foot-level amputation had a previous history of amputation. However, nearly 40% of subjects undergoing foot amputations had not been diagnosed either before or during admission with peripheral arterial occlusive disease, suggesting a causal pathway dependent primarily on neuropathy. This implies that better screening of diabetic patients with appropriate risk-directed treatment at the primary care level may significantly impact the large number of preventable diabetes-related lower extremity amputations.

The Use of Skin Temperature Determinations in Lower Extremity Amputation Level Selection

Foot & Ankle ◽  
1982 ◽  
Vol 3 (3) ◽  
pp. 170-172 ◽  
Author(s):  
Frank L. Golbranson ◽  
Eric C. Yu ◽  
Richard H. Gelberman
Keyword(s):  
Lower Extremity ◽  
Surface Temperature ◽  
Skin Temperature ◽  
Room Temperature ◽  
Lower Extremity Amputation ◽  
Peripheral Vascular ◽  
Amputation Level ◽  
The Difference ◽  
Skin Temperatures ◽  
Extremity Amputation

Skin temperatures were recorded preoperatively with a surface temperature probe in 30 limbs of 26 patients undergoing amputations for peripheral vascular disease. A significant correlation was established between the temperature readings and stump survival at the selected levels. All amputation levels with temperature readings above 32° C healed, and all those with readings below 30.5° C failed to heal. If the difference between skin temperature and room temperature was less than 5° C the amputation generally failed.

scholarly journals The impact of gender, level of amputation and diabetes on prosthetic fit rates following major lower extremity amputation

2016 ◽  
Vol 41 (1) ◽  
pp. 19-25 ◽  
Author(s):  
Fiona Davie-Smith ◽  
Lorna Paul ◽  
Natalie Nicholls ◽  
Wesley P Stuart ◽  
Brian Kennon
Keyword(s):  
Diabetes Mellitus ◽  
Peripheral Arterial Disease ◽  
Lower Extremity ◽  
Clinical Relevance ◽  
Arterial Disease ◽  
Lower Extremity Amputation ◽  
Amputation Level ◽  
Prosthetic Limb ◽  
Peripheral Arterial ◽  
Extremity Amputation

Background: Diabetes mellitus is a leading cause of major lower extremity amputation. Objective: To examine the influence of gender, level of amputation and diabetes mellitus status on being fit with a prosthetic limb following lower extremity amputation for peripheral arterial disease. Study design: Retrospective analysis of the Scottish Physiotherapy Amputee Research Group dataset. Results: Within the cohort with peripheral arterial disease ( n = 1735), 64% were men ( n = 1112) and 48% ( n = 834) had diabetes mellitus. Those with diabetes mellitus were younger than those without: mean 67.5 and 71.1 years, respectively ( p < 0.001). Trans-tibial amputation:trans-femoral amputation ratio was 2.33 in those with diabetes mellitus, and 0.93 in those without. A total of 41% of those with diabetes mellitus were successfully fit with a prosthetic limb compared to 38% of those without diabetes mellitus. Male gender positively predicted fitting with a prosthetic limb at both trans-tibial amputation ( p = 0.001) and trans-femoral amputation ( p = 0.001) levels. Bilateral amputations and increasing age were negative predictors of fitting with a prosthetic limb ( p < 0.001). Diabetes mellitus negatively predicted fitting with a prosthetic limb at trans-femoral amputation level ( p < 0.001). Mortality was 17% for the cohort, 22% when the amputation was at trans-femoral amputation level. Conclusion: Of those with lower extremity amputation as a result of peripheral arterial disease, those with diabetes mellitus were younger, and more had trans-tibial amputation. Although both age and amputation level are good predictors of fitting with a prosthetic limb, successful limb fit rates were no better than those without diabetes mellitus. Clinical relevance This is of clinical relevance to those who are involved in the decision-making process of prosthetic fitting following major amputation for dysvascular and diabetes aetiologies.

scholarly journals HEMODIALYSIS IS NOT ASSOCIATED WITH PRE-PROSTHETIC INPATIENT REHABILITATION OUTCOMES AFTER DYSVASCULAR LOWER EXTREMITY AMPUTATION: A RETROSPECTIVE COHORT STUDY

2020 ◽  
Vol 3 (2) ◽  
Author(s):  
W. Shane Journeay ◽  
Michelle G. Marquez ◽  
Matthew Kowgier
Keyword(s):  
Length Of Stay ◽  
Lower Extremity ◽  
Functional Outcomes ◽  
Retrospective Cohort ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Lower Extremity Amputation ◽  
Limb Loss ◽  
Amputation Level ◽  
Extremity Amputation

BACKGROUND: Lower extremity amputation due to complications from peripheral vascular disease and/or diabetes are common and these patients often have multiple comorbidities. Patients with end-stage renal disease receiving hemodialysis (ESRD/HD) are a particularly vulnerable group at risk for amputation. After lower extremity amputation (LEA) surgery, many patients undergo post-operative inpatient rehabilitation to improve their pre-prosthetic functional independence. Given the increased complexity of dysvascular patients living with ESRD/HD compared to those without ESRD/HD, the association of HD with pre-prosthetic inpatient functional outcomes warrants further study. OBJECTIVE: The objective of this study was to compare the pre-prosthetic functional outcomes and Length of Stay (LOS) among patients with recent dysvascular LEA with and without ESRD/HD. METHODOLOGY: A retrospective cohort design was used to analyze a group of 167 patients with unilateral, dysvascular limb loss who were admitted to inpatient rehabilitation with 24 of these patients in the ESRD/HD group.  Age, gender, amputation level, amputation side, length of stay (LOS), time since surgery, Functional Independence Measure (FIM) scores (admission and discharge), and Charlson Comorbidity Index (CCI) were collected. FINDINGS:  There was no difference between patients with dysvascular amputation with and without ESRD/HD in the association of functional outcomes or LOS in this cohort and rehabilitation model. The CCI score was higher in the ESRD/HD group. Multivariate analysis indicated an inverse relationship with age and FIM scores, where increased age was associated with lower Total and Motor FIM at admission and discharge. There were no associations with FIM change. Age was positively associated with LOS. Being female was inversely associated to motor FIM scores at admission and discharge CONCLUSION: Among patients with recent dysvascular LEA, ESRD/HD is not associated with different functional outcomes or LOS in the pre-prosthetic inpatient rehabilitation setting. This suggests that despite added comorbidity that patients with ESRD/HD may still benefit from inpatient rehabilitation to optimize pre-prosthetic function. Layman's Abstract Lower extremity limb loss caused by blood vessel disease and/or diabetes is common. Patients who need amputation often have additional medical conditions that may impact their recovery after surgery. One such condition, is diabetes-related poor kidney function requiring hemodialysis. Patients who attend hemodialysis are particularly vulnerable to limb amputation. After amputation surgery many individuals undergo inpatient rehabilitation to improve self-care and mobility prior to discharge from hospital and before being considered for a prosthesis. In patients who are admitted to rehabilitation hospitals after amputation we understand very little about how the demands of hemodialysis may impact their rehabilitation and how long they stay in a rehabilitation hospital. The objective of this study was to compare patients with amputation due to blood vessel disease and/or diabetes with patients who also require hemodialysis. We studied their functional outcomes and inpatient rehabilitation length of stay in hospital. 167 patients with unilateral, limb loss who were admitted to an inpatient rehabilitation hospital were included in the analysis with 24 of these patients attending hemodialysis.  Age, sex, amputation level, amputation side, length of stay, time since surgery, Functional Independence Measure scores (measure of a patient’s function) and Charlson Comorbidity Index (measure of multiple medical conditions) were collected. We concluded that in patients with recent limb amputation, hemodialysis was not related to different functional outcomes or time in hospital in the inpatient rehabilitation setting. This suggests that despite receiving hemodialysis, patients with recent limb loss may still benefit from inpatient rehabilitation before being considered for a prosthesis. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/34471/26580 How To Cite: Journeay W.S., Marquez M.G., Kowgier M. Hemodialysis is not associated with pre-prosthetic inpatient rehabilitation outcomes after dysvascular lower extremity amputation: a retrospective cohort study. Canadian Prosthetics & Orthotics Journal. 2020; Volume 3, Issue 2, No.2. https://doi.org/10.33137/cpoj.v3i2.34471 Corresponding Author: Dr. W. Shane Journeay, PhD, MD, MPH, FRCPC, BC-Occ MedProvidence Healthcare – Unity Health Toronto, 3276 St Clair Avenue East, Toronto ON M1L 1W1E-mail: [email protected]: https://orcid.org/0000-0001-6075-3176

scholarly journals Assessment of quality of life in patients after lower limb amputation

2015 ◽  
Vol 68 (3-4) ◽  
pp. 103-108 ◽  
Author(s):  
Aleksandar Knezevic ◽  
Tatjana Salamon ◽  
Miroslav Milankov ◽  
Srdjan Ninkovic ◽  
Milica Jeremic-Knezevic ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lower Extremity ◽  
Physical Functioning ◽  
Lower Extremity Amputation ◽  
Control Group ◽  
Amputation Level ◽  
Sf 36 ◽  
Experimental Group ◽  
Extremity Amputation

Introduction. Lower extremity amputation is a surgical procedure resulting in important anatomical, functional, psychological, and social consequences that can influence the quality of life of these patients. The aim of this research was to compare the quality of life of patients with lower extremity amputation and people without amputation taking into account gender differences as well as the amputation level. Material and Methods. The study was designed as a cross-sectional study which included 56 subjects. The patients from the experimental group underwent prosthetic rehabilitation treatment at the Department of Medical Rehabilitation, Clinical Centre of Vojvodina. The experimental group included 28 patients (21 male, 7 female) with lower extremity amputation, their average age being 65.36?13.64. The control group consisted of 28 age and gender matching subjects without amputation. Research ANd Development (RAND) 36 - Item Health Survey 1.0 (SF - 36) was used to measure the quality of life. Results. The results showed that patients with lower extremity amputation scored lower than the control group on all SF- 36 variables (p<0.05). None of the SF-36 variables differed between the genders (p>0.05). Seventeen (61%) patients were with transfemoral, and 11 (39%) with transtibial level of amputation. The patients with transtibial amputations scored higher on physical functioning and general health status variables (p<0.05). Conclusion. The patients with lower extremity amputations have numerous limitations compared to the control group, regardless of gender, while the patients with lower level of amputation have a higher level of physical functioning.

scholarly journals Lower Limb Amputation Rates in Germany

Medicina ◽  
2022 ◽  
Vol 58 (1) ◽  
pp. 101
Author(s):  
Nike Walter ◽  
Volker Alt ◽  
Markus Rupp
Keyword(s):  
Lower Extremity ◽  
Lower Limb ◽  
Arterial Disease ◽  
Lower Extremity Amputation ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Amputation Level ◽  
Patient Optimization ◽  
Peripheral Arterial ◽  
Extremity Amputation

Background and Objectives: The current epidemiology of lower limb amputations is unknown. Therefore, the purpose of this study was to determine (1) lower extremity amputation rates as a function of age, gender, and amputation level between 2015 and 2019, (2) main diagnoses indicating amputation, (3) revision rates after lower extremity amputation. Materials and Methods: Lower extremity amputation rates were quantified based on annual Operation and Procedure Classification System (OPS) and International Classifications of Disease (ICD)-10 codes from all German medical institutions between 2015 through 2019, provided by the Federal Statistical Office of Germany (Destatis). Results: In 2019, 62,016 performed amputations were registered in Germany. Out of these 16,452 procedures (26.5%) were major amputations and 45,564 patients (73.5%) underwent minor amputations. Compared to 2015, the incidence of major amputations decreased by 7.3% to 24.2/100,000 inhabitants, whereas the incidence of minor amputation increased by 11.8% to 67.1/100,000 inhabitants. Highest incidence was found for male patients aged 80–89 years. Patients were mainly diagnosed with peripheral arterial disease (50.7% for major and 35.7% for minor amputations) and diabetes mellitus (18.5% for major and 44.2% for minor amputations). Conclusions: Lower limb amputations remain a serious problem. Further efforts in terms of multidisciplinary team approaches and patient optimization strategies are required to reduce lower limb amputation rates.

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