title: Delay influences outcome after lower limb major amputation.
abstract: OBJECTIVE
  To investigate if a relationship exists between hospital waiting time to major amputation and outcome.
  
  
  METHODS
  All patients undergoing major lower limb amputation in England between April 2002 and March 2006 were identified from the Hospital Episodes Statistics (HES) data. Amputations related to trauma or malignancy were excluded. The length of wait (LOW), from date of admission to date of major amputation was calculated. A two-level regression model was used to investigate if LOW had a significant effect on recovery time and in-hospital mortality. Results were adjusted for age, sex, Charlson score, Social Deprivation, mode of intervention (bypass/angioplasty/no intervention) and mode of admission (emergency/elective).
  
  
  RESULTS
  14,168 major amputations were identified. 12,884 (90.9%) had no intervention prior to amputation on that admission. Length of Wait (LOW) significantly prolonged recovery in men (Exponential Estimate 1.01 1.01-1.02 p < 0.0001) and women (EE 1.02 1.01-1.02 p < 0.0001) and increased in-hospital mortality in men (OR 1.02 1.02-1.03 p < 0.0001). Risk of in-hospital death increased by 2% for each day waited.
  
  
  CONCLUSIONS
  Delays in decision making or in getting a patient into the operating theatre have a negative effect on patient outcome in terms of overall length of stay and mortality after major lower limb amputation.
authors.affiliation: Department of Outcomes Research, St George's Vascular Institute, St George's Healthcare NHS Trust, London, UK. paul.moxey@nhs.net
authors.forename: P W
authors.initials: PW
authors.lastname: Moxey
authors.forename: D
authors.initials: D
authors.lastname: Hofman
authors.forename: R J
authors.initials: RJ
authors.lastname: Hinchliffe
authors.forename: J
authors.initials: J
authors.lastname: Poloniecki
authors.forename: I M
authors.initials: IM
authors.lastname: Loftus
authors.forename: M M
authors.initials: MM
authors.lastname: Thompson
authors.forename: P J
authors.initials: PJ
authors.lastname: Holt
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000009:adverse effects / Q000401:mortality; D017130:Angioplasty; D004739:England; D005260:Female; D017052:Hospital Mortality; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D023821:Limb Salvage; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010343:Patient Admission; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures