P90 PERCEIVE: PrEdiction of Risk and Communication of outcome following major lower limb amputation - a collaboratIVE study

Abstract Introduction Major Lower Limb Amputation (MLLA) is a life changing event with significant morbidity and mortality. Inaccurate risk prediction can lead to poor decision making, resulting in delay to definitive surgery, or undertaking amputation when not in the patient’s best interest. We aim to answer: In adult patients undergoing MLLA for chronic limb threatening ischaemia or diabetes, how accurately do health care professionals prospectively predict outcomes after MLLA, and how does this compare to existing prediction tools? Methods A multicentre prospective observational cohort study is being delivered through the Vascular and Endovascular Research Network. Dissemination was via an existing network of contacts and social media. Consecutive data will be collected for seven months from site launch date, including demographic data and pre-operative outcome predictions from surgeons, anaesthetists, and allied healthcare professionals. Follow-up data will comprise 30-day (mortality, morbidity, MLLA revision, surgical site infection, and blood transfusion) and 1-year (mortality, MLLA revision and ambulation). The accuracy of surgeons’ predictions will be evaluated and compared to pre-existing risk prediction scoring tools. Results PERCEIVE launched on 01/10/2020 with 23 centres (16 UK, 7 international) registered to collect data. 50 other centres (27 UK, 23 international) have expressed interest/are pursuing local audit/ethical approval. We aim to collect data on clinicians estimate of outcomes for over 500 patients. Discussion This study will utilise a trainee research network to provide data on the accuracy of healthcare professionals’ predictions of outcomes following MLLA and compare this to the utility of existing prediction tools in this patient cohort.

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A Systematic Review and Narrative Synthesis of Risk Prediction Tools Used to Estimate Mortality, Morbidity, and Other Outcomes Following Major Lower Limb Amputation

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2021.02.038 ◽

2021 ◽

Author(s):

Ryan A. Preece ◽

Nafi Dilaver ◽

Cherry-Ann Waldron ◽

Philip Pallmann ◽

Emma Thomas-Jones ◽

...

Keyword(s):

Systematic Review ◽

Risk Prediction ◽

Lower Limb ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Narrative Synthesis ◽

Prediction Tools

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Research priorities for lower limb amputation in patients with vascular disease

10.1101/2021.05.21.21256746 ◽

2021 ◽

Author(s):

David Bosanquet ◽

Sandip Nandhra ◽

Kitty Wong ◽

Judith Long ◽

Ian Chetter ◽

...

Keyword(s):

Vascular Surgery ◽

Lower Limb ◽

Healthcare Professionals ◽

Research Priorities ◽

Lower Limb Amputation ◽

Nominal Group ◽

Phantom Limb ◽

Limb Amputation ◽

Specific Research ◽

Research Questions

Introduction Lower limb amputation is a life-changing event for patients and can be associated with high mortality and morbidity rates. Research into this critical part of vascular surgery is limited. The Vascular Society of Great Britain and Ireland (VSGBI) in partnership with the James Lind Alliance (JLA) process, aimed to identify and develop key research priorities for amputation. Methods A modified JLA Priority Setting Partnership was undertaken, encompassing all vascular practice. Two separate Delphi processes to identify research topics were undertaken with healthcare professionals, patients and carers, led by the VSGBI. The priorities were then ranked by the same participants and amalgamated to produce a list for final prioritisation. The final consensus meeting was attended by patients, carers and healthcare professionals from a variety of backgrounds involved in the care of people with amputation. Using a nominal group technique, the top ten research priorities were identified. Results A total of 481 clinicians submitted 1231 research questions relating to vascular surgery in general. 63 amputation-specific research questions were combined into 5 final clinical questions. 373 patients or carers submitted 582 research questions related to vascular surgery in general. Nine amputation-specific research questions were identified after combining similar questions. Amalgamating both the clinician and patient questions, 12 questions were discussed at the final prioritisation meeting and the top 10 identified. These related to amputation prevention, supporting rehabilitation, improving clinical outcomes following amputation (preventing/treating pain including phantom limb pain and improving wound healing) and research into information provision for patients undergoing amputation. Conclusion The top 10 research priority areas in vascular amputation provide guidance for researchers, clinicians, and funders on the direction of future research questions that are important to both healthcare professionals and patients.

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Development and validation of risk prediction equations to estimate future risk of blindness and lower limb amputation in patients with diabetes: cohort study

BMJ ◽

10.1136/bmj.h5441 ◽

2015 ◽

Vol 351 (nov11 1) ◽

pp. h5441-h5441 ◽

Cited By ~ 20

Author(s):

J. Hippisley-Cox ◽

C. Coupland

Keyword(s):

Cohort Study ◽

Risk Prediction ◽

Lower Limb ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Prediction Equations ◽

Patients With Diabetes ◽

Future Risk ◽

Development And Validation

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Research priorities for lower limb amputation in patients with vascular disease

Journal of Vascular Societies Great Britain and Ireland ◽

10.54522/jvsgbi.2021.001 ◽

2021 ◽

Vol 1 (1) ◽

pp. 11-16

Author(s):

DC Bosanquet ◽

S Nandhra ◽

KHF Wong ◽

J Long ◽

I Chetter ◽

...

Keyword(s):

Vascular Surgery ◽

Lower Limb ◽

Healthcare Professionals ◽

Research Priorities ◽

Consensus Meeting ◽

Lower Limb Amputation ◽

Nominal Group ◽

Phantom Limb ◽

Limb Amputation ◽

Specific Research

Introduction: Major lower limb amputation (MLLA) is a life-changing event often associated with high mortality and morbidity rates. Research into MLLA surgery is limited. The Vascular Society of Great Britain and Ireland (VSGBI) in partnership with the James Lind Alliance (JLA) aimed to identify and develop key research priorities for MLLA. Methods: A modified JLA Priority Setting Partnership was undertaken, encompassing all vascular practice. Two separate Delphi processes to identify research priorities were undertaken with healthcare professionals, patients and carers, led by the VSGBI. The priorities were then scored by the same participants and amalgamated to produce a list for final ranking. The final consensus meeting was attended by patients, carers and healthcare professionals from a variety of backgrounds involved in the care of people with MLLA. Using a nominal group technique, a ranked list of the top ten research priorities were identified. Results: A total of 481 clinicians submitted 1,231 research priorities relating to vascular surgery in general. Sixty-three MLLA-specific research priorities were combined into five final priorities. Three hundred and seventy-three patients or carers submitted 582 research priorities related to vascular surgery in general. Nine MLLA-specific research priorities were identified after combining similar priorities. The final consensus meeting produced a ranked top 10 list of research priorities relating to: MLLA prevention, supporting rehabilitation, improving clinical outcomes following MLLA (preventing/treating pain including phantom limb pain and improving wound healing) and research into information provision for patients undergoing MLLA. Conclusions: The top 10 MLLA research priorities provide guidance for researchers, clinicians and funders on the direction of future research questions that are important to both healthcare professionals and patients.

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