Trends and outcomes of non-traumatic major lower extremity amputations in an Irish tertiary referral hospital
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ORIGINAL ARTICLE
Trends and outcomes of non-traumatic major lower extremity amputations in an Irish tertiary referral hospital Seán C. Maguire 1 & H. M. Mohan 1 & C. Fenelon 1 & J. Stow 2 & P. Nicholson 1 & A. Huang 1 & N. Ryall 2 & S. Sheehan 1 & D. Mehigan 1 & J. Dowdall 1 & M. C. Barry 1 Received: 28 February 2020 / Accepted: 2 April 2020 # Royal Academy of Medicine in Ireland 2020
Abstract Objectives Data on vascular patients following amputation in Ireland is lacking, limiting capability to plan services. This paper seeks to benchmark survival and rehabilitation outcomes among vascular patients in Ireland following lower extremity amputation (LEA), and compare subgroups of those undergoing transfemoral (TFA) or transtibial amputation (TTA). Methods A review was conducted of all patients who underwent non-traumatic TFA or TTA from 2000 to 2009 in a tertiary vascular surgery centre. Demographics, surgical data, perioperative outcomes, medium-term functional outcomes, and survival were assessed. Results One hundred and seventy-two patients (2:1 male: female) underwent 192 non-traumatic LEAs. Median age for TFA was 75 years and TTA 67 (p = 0.002). A percentage of 36.5% had undergone prior attempts at surgical revascularization, 25% had undergone prior distal amputation or debridement. Thirty-three (17%) required stump revision. Twenty-three (13.2%) died in hospital. Median survival for those who died in hospital was 17 days (0–367), versus 17 months (2–106) for those who survived to discharge. Conclusion LEA for vascular pathology has significant morbidity and mortality, with long in-patient stays and short median survival; there is need to focus on improving quality of life in postoperative pathways. Keywords Lower extremity amputation . Transfemoral . Transtibial amputation
Background The incidence of the two major risk factors for LEA, diabetes and peripheral vascular disease (PVD), remain highly prevalent [1–4]. Public understanding of these conditions is relatively poor compared to other diseases, with limited awareness of their potential consequences [5–7]. Those with diabetes are 15 to 40 times more likely than non-diabetics to undergo amputation, and 53% of all LEA patients in Ireland are diabetic [8]. This is of increasing concern with the increasing prevalence of these conditions, currently estimated to be 4.5 to 8.8% of the general population [1–4]. These conditions are
* Seán C. Maguire [email protected] 1
Department of Vascular Surgery, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
2
National Rehabilitation Hospital, Dun Laoghaire, Co. Dublin, Ireland
significant risk factors for LEA, and rates of amputation for diabetes mirror this trend in a significantly morbid population [4, 9, 10]. A 5-year survival following LEA is comparable to or worse than for most malignancies [9, 11]. Perioperative mortality is reported to be lower in those whom were selected for TTA (6.5%) compared to TFA (12.8%) [12, 13]. The higher level of amputation has correlates with frailty and morbidity.
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