title: Surgical experience and supervision may influence the quality of lower limb amputation.
abstract: OBJECTIVE
  Only half of those patients undergoing major lower limb amputations for peripheral vascular disease (PVD) are likely to mobilise on a prosthesis. This study aimed to determine whether a surgeon's experience influenced the quality of the residual limb and thus the likelihood of the stump being suitable for a prosthesis.
  
  
  METHODS
  All patients undergoing major lower limb amputations for PVD were recruited prospectively, between August 1992 and July 1996. Following surgery, patients were categorised, by a consultant in rehabilitation medicine, as potentially suitable (group 1) or unsuitable (group II) for rehabilitation. Patients in group I were further assessed by prosthetists for limb fitting.
  
  
  RESULTS
  A total of 217 patients underwent 260 amputations for PVD between 1992 and 1996: transfemoral (TFA) 131, trans-tibial (TTA) 127, and through-knee (TKA) in 2. The 30-day mortality was 12% (n = 27). Following surgery, 109 patients were assigned to group I (51%), and 81 patients to group II (37%). The proportion of junior surgeons performing surgery was similar for patients in both groups. Twenty-three amputation stumps (9%) required revision or conversion to a higher level within 30 days. Revisions or conversions were significantly more frequent where the original operation had been performed by an unsupervised junior surgeon rather than a senior surgeon (P = 0.009). The rate of defective amputations compromising limb fitting also reached significance when unsupervised junior and senior surgeons were compared (P = 0.04).
  
  
  CONCLUSIONS
  Rehabilitation of the relatively few amputees who reach the stage of limb fitting is hindered by poor surgical technique in a large proportion of cases. Patients operated on by a more experienced surgeon had a better chance of mobilising without revision or conversion surgery.
authors.affiliation: Vascular Surgical Unit, Derriford Hospital, Plymouth, UK. chryz.cosgrove@phnt.swest.nhs.uk
authors.forename: C M
authors.initials: CM
authors.lastname: Cosgrove
authors.forename: D J
authors.initials: DJ
authors.lastname: Thornberry
authors.forename: D C
authors.initials: DC
authors.lastname: Wilkins
authors.forename: S
authors.initials: S
authors.lastname: Ashley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000534:rehabilitation / Q000592:standards*; D002983:Clinical Competence / Q000592:standards*; D004739:England; D005260:Female; D006801:Humans; D007866:Leg / Q000601:surgery*; D008297:Male; D008505:Medical Staff, Hospital / Q000592:standards; D008875:Middle Aged; D011446:Prospective Studies; D011787:Quality of Health Care