DOS Kongressen 2014 ·
111
Markedly reduced mortality following a major
non-traumatic lower limb amputation
Morten Tange Kristensen, Gitte Holm, Michael Krasheninnikoff, Peter Gebuhr
Physical Medicine and Rehabilitation Research - Copenhagen, Depertments
of Physiotherapy and Orthopa, Hvidovre University Hospital; Department of
Orthopaedic Surgery, Hvidovre University Hospital
Background:
Historically high 30-days and 1-year mortality rates of respec-
tively 30% and 54% were reported in a Danish 2009 consecutive series of 93
patients with a non-traumatic lower limb amputation.
Purpose / Aim of Study:
To evaluate if allocation of staff expertise and insti-
tuting an optimized program could reduce the number of these fatal events.
Materials and Methods:
A consecutive series of 129 amputations (median
age of 75 (IQR, 65-84) years, 53% below knee (BKA) and 47% amputated at
a higher level or bilateral (AKA), admitted to an orthopaedic ward. The program
instigated within a 2-year period included standards for fluid and transfusion,
supplemental oxygen when supine, pain management, early mobilization and
physiotherapy, weekly multidisciplinary meetings, and monthly audits of stan-
dards.
Findings / Results:
Twenty (16%) and 48 (37%) patients respectively, died
within 30-days and 1-year. Cox regression demonstrated that a patient from
a nursing home (n=26) and/or an ASA-rating of 4 (n = 12) respectively, was
3 and 5 times more likely to die within 30 days, compared to a patient with an
rating of 2 (n = 41), when adjusted for age, gender, cause of and amputation
level. Length of stay was reduced with a mean of 6 days.
Conclusions:
Allocating people with expertise and instituting an optimized
program seem to reduce the short and long-term mortality rates markedly in
patients with a major lower limb amputation.
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