Outcomes of major lower extremity amputations n dysvascular patients: Room for improvement

O’Banion, Leigh Ann; Dirks, Rachel; Farooqui, Emaad; Kaups, Krista L.; Qumsiyeh, Yazen; Rome, Cambia; Davis, James W.

doi:10.1016/j.amjsurg.2020.08.020

Cited by 9 publications

(7 citation statements)

References 16 publications

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“…O'Banion and Lavery both found that patients who were discharged home after LA were significantly younger than those who were discharged to inpatient facilities. 35,38 This trend is consistent with other surgical interventions, including after long bone fractures Van Der & Freburger. 39, 40 We also found that patients 50 to 69 years of age were more likely to discharge H/W than their younger or older counterparts.…”

Section: Discussionsupporting

confidence: 86%

Discharge Disposition After Limb Amputation in a Publicly Funded Health Care System

Essien

Zucker-Levin

2023

INQUIRY

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Understanding discharge disposition (DD) after limb amputation (LA) surgery allows health care providers and policy makers to adapt resources based on need. Studying independent prognostic factors for DD after LA in Canada eliminates the significant influence of payor source, as reported by researchers in the United States. We hypothesize disparities exist among DDs after LA in a publicly funded health care system. Retrospective review of Saskatchewan’s linked administrative health data from 2006 to 2019 was used to identify independent socio-demographic factors, amputation levels, amputation predisposing factors (APF), and surgical specialty on 5 DD’s: inpatient, continuing care, home with support services (H/W), home with no support services (H/WO), and those who died at the hospital after LA. We found age, amputation level, and APF play a significant role in determining discharge to all dispositions; gender was significantly associated with discharge to continuing care and H/WO; place of residence was associated with discharge to inpatient facilities, continuing care, and H/W; income was not associated with any DD other than H/W; surgical specialty was associated with discharge to all dispositions except death. The findings suggest that disparities in DD following LA exist even after eliminating the influence of payor source. Health care providers and policy makers should consider these findings in preparation for future needs.

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Section: Discussionsupporting

confidence: 86%

Discharge Disposition After Limb Amputation in a Publicly Funded Health Care System

Essien

Zucker-Levin

2023

INQUIRY

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“…In addition, as the patient was amputated because of dysvascular problems, she gained benefit of not being in prolonged immobilization that could lead to another complication of peripheral vascular disease. 2,9 The patients had therapeutic exercise for six months, such as range of motion exercise and positioning to prevent development of knee flexion contracture, which often happens in the transtibial amputation. Contractures are preventable through a postoperative therapy program that emphasizes range of motion exercises and early mobilization.…”

Section: Discussionmentioning

confidence: 99%

Dysvascular Transtibial Amputation Due To Artery Stenosis: A Case Report Study

Imanawanto

Utami

2022

SPMRJ

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Below-knee (BK) amputation is one of the most commonly performed actions in dysvascular cases, but rare caused by arterial stenosis. Those had significant impacts on clinical functions and affect the contralateral limb, so its need adequate supervision during rehabilitation programs. The report are to describe the stump wound healing of the patient after amputation surgery, stump preparation at pre-prosthetic phase, prevention of knee contracture, prosthetic preparation and use, gait training and evaluation of unaffected limb. A 44-years old female with right below-knee amputation caused by stenosis of right peroneal and dorsalis pedis artery, and the wound in the residual limb was not healed within 4 weeks. She got rehabilitation to accelerate stump healing and stump shaping, maintain knee flexibility, muscle strengthening, cardiovascular endurance, transfer and ambulation. She had good compliance to the programs and achieved independent ambulation using the prosthetic within 6 months. Improvement in residual limb healing within 6 weeks, pain reduction from VAS score 3 to zero, and stump shape changes from buldging to conical. And also in knee joint range of motion, transfer ability, gait pattern using BK prosthetic (by modifying shoe components), and the patient's ability to carry out ADL (BI score 75 to 100). Laser therapy, stump shaping, flexibility exercise, strengthening exercise, endurance exercise, ambulation exercise and prosthetic use on transtibial dysvascular amputation showed good results for ADL. Careful examination to the unaffected limb could identify early occurence of stenosis. Early intervention could prevent future ischaemia and amputation.

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“…Few LEA patients achieve independent mobility within the first post‐amputation days, and this increases to approximately 50% at discharge from the acute hospital 6 . Studies have shown that early mobilization out of bed starting as early as on the first postoperative day for patients with LEA seems to increase physical function, 8–11 and reduce mortality and complications 6,7 . Yet, early mobilization is complex and not achievable for all LEAs 6 .…”

Section: Introductionmentioning

confidence: 99%

Fatigue, fear of being mobilized and residual limb pain limit independent basic mobility and physiotherapy for patients early after major dysvascular lower extremity amputation: A prospective cohort study

Berger,

Nielsen,

Stie

et al. 2024

Geriatrics Gerontology Int

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AimEarly mobilization of patients with a major lower extremity amputation (LEA) is often a challenge because of lack of compliance. Therefore, we investigated factors limiting independent mobility and physiotherapy on the first day with physiotherapy (PTDay1) and the following 2 days after LEA.MethodsA total of 60 consecutive patients, mean age 73.7 years (SD 12.1 years), undergoing LEA were included over a period of 7 months. The Basic Amputee Mobility Score was used to assess basic mobility. Predefined limitations for not achieving independent mobility or not completing physiotherapy were residual limb pain, pain elsewhere, fear of being mobilized, fatigue, nausea/vomiting, acute cognitive dysfunction or “other” factors reported on PTDay1 and the following 2 days after LEA.ResultsFatigue and fear of being mobilized were the most frequent limitations for not achieving independent mobility on PTDay1 and the following 2 days after LEA. Patients (n = 55) who were not independent in the Basic Amputee Mobility Score activity transferring from bed to chair on PTDay1 were limited by fatigue (44%) and fear of being mobilized (33%). A total of 21 patients did not complete planned physiotherapy on PTDay1, and were limited by fatigue (38%), residual limb pain (24%) and “other” factors (24%).ConclusionFatigue and fear of being mobilized were the most frequent factors that limited independent mobility early after LEA. Fatigue, residual limb pain and “other” factors limited completion of physiotherapy. Geriatr Gerontol Int 2024; ••: ••–••.

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Outcomes of major lower extremity amputations n dysvascular patients: Room for improvement

Cited by 9 publications

References 16 publications

Discharge Disposition After Limb Amputation in a Publicly Funded Health Care System

Discharge Disposition After Limb Amputation in a Publicly Funded Health Care System

Dysvascular Transtibial Amputation Due To Artery Stenosis: A Case Report Study

Fatigue, fear of being mobilized and residual limb pain limit independent basic mobility and physiotherapy for patients early after major dysvascular lower extremity amputation: A prospective cohort study

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