Factors that affect the one-year mortality rate after lower limb amputation in the Hong Kong Chinese population

Introduction Lower limb amputation has significant morbidity and mortality. This study reviews the potential factors affecting the one-year mortality rate after lower limb amputation in the Hong Kong Chinese population. Methods Cases with lower limb amputations (toe, ray, below-knee, and above-knee amputations) from a regional hospital from January 2016 to December 2017 were recruited. Amputations due to trauma were excluded. The one-year mortality rate and the potential risk factors (age, sex, length-of-stay, multiple operations, extent of surgery (minor vs. major), medical comorbidities including (1) end-stage renal failure (ESRF), (2) cardiac diseases, (3) ischemic heart disease, (4) peripheral vascular disease and (5) diabetes mellitus) were analyzed by multiple logistic regression using Matlab 2018a. Results A total of 132 patients were recruited (173 operations). The one-year mortality rate was 36.3%. The mean age at death was 72.2 years. The results of the regression analysis showed patients having ESRF (β = 2.195, t 120 = 3.008, p = 0.003) or a major amputation (including above- or below-knee amputation) (β = 1.079, t 120 = 2.120, p = 0.034), had a significantly higher one-year mortality. The remaining factors showed no significant effect. The one-year mortality rate in ESRF patients was 77.8%; while the one-year mortality rate without ESRF was 29.8%. The mean age at death in the ESRF group was 62.9 years; while that without ESRF was 76.1 years. The one-year mortality for patients with major amputation was 45.8% while that for minor amputation was 20.4%. Conclusion ESRF and major amputation are factors that increase the one-year mortality rate after lower limb amputation.

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Factors associated with mobility apprehension in persons with lower limb amputation

Prosthetics and Orthotics International ◽

10.1177/0309364620915017 ◽

2020 ◽

Vol 44 (4) ◽

pp. 208-214

Author(s):

Shannon L Mathis

Keyword(s):

Standard Deviation ◽

Lower Limb ◽

Avoidance Behavior ◽

Pain Catastrophizing ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Walking Ability ◽

Factors Associated ◽

The Mean ◽

The Impact

Background: Factors that are related to mobility apprehension were measured in a sample of persons with lower-limb amputation. Objectives: The purpose was to determine whether intensity, interference, or catastrophizing are associated with mobility apprehension. Study design: Cross-sectional study. Methods: Persons with amputation of a lower limb who were attending a national limb loss conference were recruited to complete a survey. Subjects were administered the Tampa Scale for Kinesiophobia to measure mobility apprehension. The Brief Pain Inventory was administered to quantify the affect of pain on general activity, walking ability, and enjoyment of life. The Pain Catastrophizing Scale was administered to assess the tendency to ruminate and magnify pain sensations. A multivariable linear regression was performed to determine factors associated with mobility apprehension. Results: Fifty-three people with lower-limb amputation participated in the study. The mean (standard deviation) score for mobility apprehension was 34.2 (6.0). Mean (standard deviation) pain intensity and interference scores were 1.6 (1.7) and 2.5 (2.6), respectively. The mean (standard deviation) pain catastrophizing score was 9.1 (10). Pain catastrophizing was the only variable associated with higher mobility apprehension ( β = 0.31, p < 0.001, R2 = 0.32). Results suggest that for every one-point increase in the pain catastrophizing score, mobility apprehension will increase by 0.3 of a point. Conclusion: These preliminary results suggest that pain catastrophizing was related to mobility apprehension in this cohort of persons with lower-limb amputation. This relationship indicates that the exploration of avoidance behaviors, such as pain catastrophizing, may be useful when developing a program for physical rehabilitation. Clinical relevance Pain catastrophizing, an avoidance behavior, may be associated with higher levels of mobility apprehension in persons with major lower-limb amputation. Understanding the impact of fear-avoidance behavior will allow clinicians to identify individuals at risk for poor outcomes following amputation surgery and to develop psychological strategies to complement treatment.

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What happens to our amputees? The Darling Downs experience

Journal of Orthopaedic Surgery ◽

10.1177/2309499020958477 ◽

2020 ◽

Vol 28 (3) ◽

pp. 230949902095847

Author(s):

Varun Vasudeva ◽

Adam Parr ◽

Alan Loch ◽

Chris Wall

Keyword(s):

Lower Limb ◽

Treatment Options ◽

Major Amputation ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Mortality Data ◽

Minor Amputation ◽

Poor Outcomes ◽

American Society ◽

End Stage

Background: Major lower limb amputation is occasionally required in the management of end-stage pathology where other treatment options have failed. The primary aim of this study was to determine the 30-day and 1-year mortality rates of patients undergoing nontraumatic major lower limb amputation. Secondary aims were to investigate risk factors for poor outcomes, incidence of previous minor amputation, and the rate of subsequent major amputation. Methods: All nontraumatic, major lower limb amputations performed at Toowoomba Hospital during an 18-year period were retrospectively reviewed. Mortality data were obtained from the Queensland Registry of Births, Deaths and Marriages. Kaplan–Meier analysis was performed to determine survival after amputation. Results: A total of 147 patients were included in the study, with 104 undergoing below knee and 43 undergoing above knee amputations. Ten patients identified as having an Aboriginal and Torres Strait Islander background. For all patients, the 30-day mortality was 4.1% and 1-year mortality was 21.1%. For Indigenous patients, 30-day mortality was 10%. Previous minor amputation had occurred in 40 patients. Twenty-nine patients underwent further minor surgery after their initial major amputation, with thirteen requiring subsequent major amputation. Factors that increased mortality risk were the presence of peripheral vascular disease, an American Society of Anesthesiologists score of four and age greater than 65 years. Conclusion: The morbidity and mortality following major lower limb amputation is significant. The findings of this study highlight the importance of preventative measures to minimize the incidence of lower limb amputations in the future.

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Lower limb amputation following venous cannulation for VA-ECMO: a case report

Perfusion ◽

10.1177/02676591211050608 ◽

2021 ◽

pp. 026765912110506

Author(s):

Natasha Habr ◽

Jamal J Hoballah ◽

Jamil Borgi ◽

Caroline Hamadi ◽

Pierre Sfeir ◽

...

Keyword(s):

Lower Limb ◽

Limb Ischemia ◽

Major Amputation ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Venous Cannulation ◽

Knee Amputation ◽

Venous Cannula ◽

Arterial Insufficiency ◽

Va Ecmo

Lower limb amputation following arterial cannulation for VA-ECMO has been described in the literature. Limb ischemia however following venous cannulation is very rare and not quite understood. We present a case of limb ischemia following venous cannulation. A combination of venous congestion, compartment syndrome and subsequent arterial insufficiency is the proposed pathophysiology. Shock and use of vasopressors are compounding factors. Limb ischemia can be transient and reversible if diagnosed immediately and treated by early removal of the cannula. Our patient was unstable and ECMO dependent, and removal of the cannula was not an option. This resulted in limb loss and eventual above knee amputation. Use of the smallest appropriate venous cannula and early fasciotomy, in addition to hemodynamic optimization are measures that could help in preventing major amputation.

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Mobility one year after unilateral lower limb amputation: a modern, UK institutional report

Interactive Cardiovascular and Thoracic Surgery ◽

10.1510/icvts.2008.180422 ◽

2008 ◽

Vol 7 (6) ◽

pp. 1024-1026 ◽

Cited By ~ 18

Author(s):

N. N. Basu ◽

N. Fassiadis ◽

A. McIrvine

Keyword(s):

Lower Limb ◽

Lower Limb Amputation ◽

Limb Amputation ◽

One Year

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Incidence of lower limb amputation in people with and without diabetes: a nationwide 5-year cohort study in Japan

BMJ Open ◽

10.1136/bmjopen-2020-048436 ◽

2021 ◽

Vol 11 (8) ◽

pp. e048436

Author(s):

Fumika Kamitani ◽

Yuichi Nishioka ◽

Tatsuya Noda ◽

Tomoya Myojin ◽

Shinichiro Kubo ◽

...

Keyword(s):

Cohort Study ◽

Lower Limb ◽

Time Trend ◽

Major Amputation ◽

Significant Decline ◽

Lower Limb Amputation ◽

Amputation Rate ◽

Limb Amputation ◽

National Healthcare ◽

Minor Amputation

IntroductionThis study was conducted to investigate the incidence and time trend of lower limb amputation (LLA) among people with and without diabetes.Research design and methodsThis retrospective population-based cohort study was based on the national claims data in Japan, comprising a total population of 150 million. Data of all individuals who had LLA from April 2013 to March 2018 were obtained. We analysed the sex-adjusted and age-adjusted annual LLA rate (every fiscal year) in people with and without diabetes for major and minor amputation. To test for time trend, Poisson regression models were fitted.ResultsIn the 5-year period, 30 187 major and 29 299 minor LLAs were performed in Japan. The sex-adjusted and age-adjusted incidence of major and minor LLAs was 9.5 (people with diabetes, 21.8 vs people without diabetes, 2.3, per 100 000 person-years) and 14.9 (people with diabetes, 28.4 vs people without diabetes, 1.9, per 100 000 person-years) times higher, respectively, in people with diabetes compared with those without. A significant decline in the annual major amputation rate was observed (p<0.05) and the annual minor amputation rate remained stable (p=0.63) when sex, age and people with and without diabetes were included as dependent variables.ConclusionsThis is the first report of the national statistics of LLAs in Japan. The incidence of major and minor LLAs was 10 and 15 times higher, respectively, in people with diabetes compared with those without. A significant decline in the major amputation rate was observed, and the annual minor amputation rate remained stable during the observation period. This information can help to create an effective national healthcare strategy for preventing limb amputations, which affect the quality of life of patients with diabetes and add to the national healthcare expenditure.

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Vocational reintegration after a lower limb amputation: A qualitative study

Prosthetics and Orthotics International ◽

10.3109/03093640309167971 ◽

2003 ◽

Vol 27 (1) ◽

pp. 4-10 ◽

Cited By ~ 18

Author(s):

M. Bruins ◽

J. H. B. Geertzen ◽

J. W. Groothoff ◽

T. Schoppen

Keyword(s):

Return To Work ◽

Lower Limb ◽

Qualitative Methodology ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Structured Interviews ◽

Negative Experiences ◽

Work Tasks ◽

One Year ◽

Mean Time

The objectives of this study were to describe the process of job reintegration, to obtain more detailed information about workplace adjustments, and to assess the positive and negative experiences of amputees (in the Netherlands) who returned to paid work after their lower limb amputation. The study had a retrospective design with semi-structured interviews. The authors used a qualitative methodology to obtain detailed information on the reintegration process. Thirty-two (32) subjects participated with a mean age of 42.6 years. The mean time between amputation and return to work was nearly one year (11.5 months). The most common reasons for delay in return to work were stump problems and problems in wound healing. Fifty percent (50%) of the amputees got different work tasks or another job than before amputation, mainly because of physical restrictions caused by the amputation. The most important motives of the amputees for job reintegration were work as a form of day spending (69%) and social contacts at the workplace (66%). Bad support of the implementing body which takes care of job reintegration and employer (34%) were the most mentioned obstacle to job reintegration. Vocational workers should be regular members in the rehabilitation teams for amputees.

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Rate of and Factors Associated with Ambulation After Unilateral Major Lower-Limb Amputation at an Urban US Tertiary-Care Hospital with a Multidisciplinary Limb Salvage Team

Journal of the American Podiatric Medical Association ◽

10.7547/16-073 ◽

2017 ◽

Vol 107 (5) ◽

pp. 355-364 ◽

Cited By ~ 1

Author(s):

Laura E. Sansosti ◽

Amanda Crowell ◽

Eric T. Choi ◽

Andrew J. Meyr

Keyword(s):

Lower Limb ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Major Amputation ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Care Hospital ◽

Factors Associated ◽

Knee Amputation ◽

History Of

Background: One relatively universal functional goal after major lower-limb amputation is ambulation in a prosthesis. This retrospective, observational investigation sought to 1) determine what percentage of patients successfully walked in a prosthesis within 1 year after major limb amputation and 2) assess which patient factors might be associated with ambulation at an urban US tertiary-care hospital. Methods: A retrospective medical record review was performed to identify consecutive patients undergoing major lower-limb amputation. Results: The overall rate of ambulation in a prosthesis was 29.94% (50.0% of those with unilateral below-the-knee amputation [BKA] and 20.0% of those with unilateral above-the-knee amputation [AKA]). In 24.81% of patients with unilateral BKA or AKA, a secondary surgical procedure of the amputation site was required. In those with unilateral BKA or AKA, statistically significant factors associated with ambulation included male sex (odds ratio [OR] = 2.50) and at least 6 months of outpatient follow-up (OR = 8.10), survival for at least 1 postoperative year (OR = 8.98), ambulatory preamputation (OR = 14.40), returned home after the amputation (OR = 6.12), and healing of the amputation primarily without a secondary surgical procedure (OR = 3.62). Those who had a history of dementia (OR = 0.00), a history of peripheral arterial disease (OR = 0.35), and a preamputation history of ipsilateral limb revascularization (OR = 0.14) were less likely to walk. We also observed that patients with a history of outpatient evaluation by a podiatric physician before major amputation were 2.63 times as likely to undergo BKA as opposed to AKA and were 2.90 times as likely to walk after these procedures. Conclusions: These results add to the body of knowledge regarding outcomes after major amputation and could be useful in the education and consent of patients faced with major amputation.

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Incidence of Lower Limb Amputation in Diabetic Patients in Osijek-Baranja County

Collegium Antropologicum ◽

10.5671/ca.44.3.6 ◽

2020 ◽

Vol 44 (3) ◽

pp. 147-153

Author(s):

Silvija Canecki-Varžić ◽

Ivana Prpić-Križevac ◽

Kristina Bojanić ◽

Damir Kovač ◽

Dario Rahelić ◽

...

Keyword(s):

Lower Limb ◽

Clinical Characteristics ◽

Tertiary Care ◽

Adverse Outcomes ◽

Lower Limb Amputation ◽

University Hospital ◽

Limb Amputation ◽

Diabetic Patients ◽

Duration Of Diabetes ◽

The Mean

Amputation of the lower limb (LLA) is one of the most feared adverse outcomes among diabetic patients. Our aim was to determine the incidence of amputation in diabetic patients in Osijek-Baranja County and to examine the possible correlation between clinical characteristics of the patients and the time elapsed before the first amputation. This was a tertiary-care-based retrospective study and included 925 diabetic patients who underwent non-traumatic lower limb amputation in the University Hospital Osijek from January 1st 2008 to December 31st 2018. Data on associated cardiovascular risk factors and clinical characteristics of the patients were collected from diabetic registry of the Department of diabetes and endocrinology. A total of 278 patients had all data for further analysis. There were 1551 LLAs over a ten year period. The incidence was 6.14 per 1,000 adults with diabetes. LLA rates per 1,000 adults with diabetes decreased by 29% between 2010 and 2013 and then increased by 76% between 2014 and 2018. In ten year period incidence of amputation in diabetic patients varied from 4 to 7.8 per 1000 persons-year. We observed the same pattern in both minor and major LLA but rates of amputation above knee steadily increased 2.7 times between 2010 and 2018 (from 0.69 to 1.83 per 1000 patients-year). The mean age of patients with LLA was 67.2 years, 66% were male, mean BMI was 29.6±4.8 kg/m2 and the mean duration of diabetes was 14.7±8.2 years. There was no association between smoking, arterial hypertension and hyperlipemia, ACE inhibitor use, statin use, antiplatelet use, CVD, neuropathy and duration of diabetes before first amputation. Only sulphonylurea and insulin therapy significantly prolonged the time before the first amputation (p = 0.00001, for each). In conclusion, our study confirmed high rate of lower limb amputation in diabetic patients in Osijek-Baranja County. Incidence rates of LLA in our population are important for further improvements in diabetes care and decisions in health care policy.

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Acceptance of Illness, Quality of Life and Nutritional Status of Patients After Lower Limb Amputation Due to Diabetes Mellitus

10.21203/rs.3.rs-102679/v1 ◽

2020 ◽

Author(s):

Jan Juzwiszyn ◽

Adrianna Łabuń ◽

Wojciech Tański ◽

Anna Szymanska-Chabowska ◽

Dorota Zielińska ◽

...

Keyword(s):

Quality Of Life ◽

Diabetes Mellitus ◽

Nutritional Status ◽

Lower Limb ◽

Statistical Correlation ◽

Lower Limb Amputation ◽

Limb Amputation ◽

The Mean ◽

Acceptance Of Illness

Abstract Introduction. Diabetes mellitus is one of the most common chronic diseases with a high number of sufferers worldwide. Diabetic neuropathy and diabetic angiopathy lead to serious infectious complications which are very difficult to combat and may finally lead to the amputation of a lower limb. The aim of the study was to evaluate the quality of life, the level of acceptance of the illness and the nutritional status of patients after lower limb amputation due to diabetes. Methods. Ninety nine patients (23 men and 76 women) were enrolled into the study. They had all undergone lower limb amputation due to diabetic foot and were treated in the Department of General and Oncological Surgery. The following questionnaires were used: the WHO Quality of Life-BREF (WHOQOL–BREF), the Mini Nutritional Assessment (MNA), the Acceptance of Illness Scale (AIS) and the anonymous specific socio-demographic characteristics questionnaire.Results: The diabetes-related amputees were revealed to have a higher QoL within the social domain (mean score 64.48), an intermediate QoL – within the environmental domain (mean score 63.04) and the mental domain (mean score 59.61), and a lower QoL – within physical (somatic) domain (mean score 54.69). There was no statistical correlation between genders or between all the domains of QoL (p>0.05). The mean MNA score was 22.66, which means that patients were at risk of malnutrition. There were statistical differences between women and men as regards nutritional status (p=0.034). The mean AIS score was 27.65 (27.09 women and 29.48 men), which means that the respondents accept their disease. There was no statistical correlation between gender and the acceptance of the disease (p=0.288). There was not statistical correlation between age and QoL (p>0.05). There were statistical differences between age and nutritional status (p<0.05), and between age and acceptance of the illness (p=0.044).Conclusions: The better the quality of life was in all the domains, the better the level of acceptance of illness was. The less malnourished the patient was, the better their quality of life was in all the domains.

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