Functional outcomes of major lower limb amputation 1994-2006: A modern series
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Authors: Chan,T.;Wu,J.;G Bowring,
Publication: Internal Medicine Journal
Start Page: 8
Introduction: For some decades, there have been numerous studies on outcomes of lower extremity amputation which mostly concentrated on epidemiology, mortality and morbidity. Few studies, in fact, only four Australian studies since 1980, have provided knowledge of functional outcomes.
Aim: This study is to describe the local outcomes with major lower limb amputation in terms of morbidity, discharge destination, and functional outcomes, especially prosthetic use; and to identify areas needing further attention.
Methods: A retrospective cohort study all consecutive patients who underwent major lower limb amputations from 1994 to 2006 at the Prince of Wales Hospital, NSW, were included. Results: Two hundred and eight patients, with male to female ratio of 2:1 and average age of 70 years, were found. 43% had diabetes. Thirty percent developed wound infection as a postoperative complication. The median length of stay in acute ward and rehabilitation unit were 32 and 44 days respectively. The mortality rate was 11.6%. Those who received rehabilitation at Prince of Wales Hospital, 79% of patients returned home; 81% were prescribed with a definitive prosthesis for either functional or cosmetic use; 44% achieved community ambulation, 20% achieved household ambulation, 12% used prosthesis for transfer and exercise only; and 68% were independent with ADLs on discharge.
Conclusion: Major lower limb amputations continue to give rise to extensive length of stay and significant cost to healthcare system. More than two-thirds of patients have rehabilitation potential despite high level of comorbidities and postoperative complications. The functional outcomes after amputee rehabilitation are remarkable – in addition to high return-tohome rate, the vast majority achieved independent mobility and ADLs. All of these measures can enhance our knowledge in providing better quality of care as well as prognostic counseling to patients pre- and post-operatively. Nevertheless, further research may be needed to look into long term follow-up through multicentre prospective approach.