title: The effect of amputation level and age on outcome: an analysis of 135 amputees.
abstract: BACKGROUND
  In this retrospective study, the impact of age, amputation level and the cause of amputation were examined using the Hospital Anxiety and Depression Scale (HADS) and Medicare K scores of amputees with unilateral lower-limb amputation.
  
  
  METHODS
  In total, 135 patients with unilateral transfemoral (TF) or (TT) transtibial amputations were examined. All data were collected using questionnaires that were either self-administered or administered during an interview. The HADS was developed as a self-reporting questionnaire to detect adverse anxiety and depressive status. K code is used to describe the functional abilities of amputees.
  
  
  RESULTS
  The mean age at the time of surgery was 52.79 ± 13.08 years. The mean time since amputation was 59.20 ± 24.41 months for TT, and 60.89 ± 22.09 months for TF amputation. The HADS-A scores of the transfemoral amputation group were determined as significantly high compared to those of the transtibial group (p < 0.05). The K index of the group aged 35 years and below was significantly higher than that of the other groups (p 0.002, p 0.001, p < 0.01).
  
  
  CONCLUSIONS
  The data show higher HADS-A scores with traumatic transfemoral amputation. Therefore, adequate psychiatric evaluation and rehabilitation should be applied to all amputees, especially in cases of young, traumatic, transfemoral amputations.
  
  
  METHODS
  Level 3, retrospective comparative cohort study.
authors.affiliation: Haseki Training and Research Hospital, Fatih, 34096, Istanbul, Turkey. muratyilmazctfhsk@yahoo.com.
authors.forename: Murat
authors.initials: M
authors.lastname: Yilmaz
authors.affiliation: Dr. Lütfi Kırdar Kartal Training and Research Hospital, Semsi Denizer Cad. E5. Yanyol Cevizli Kavsagi, Kartal, 34890, Istanbul, Turkey. dgulabi@yahoo.com.
authors.forename: Deniz
authors.initials: D
authors.lastname: Gulabi
authors.affiliation: Haseki Training and Research Hospital, Fatih, 34096, Istanbul, Turkey. drikaya27@hotmail.com.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Kaya
authors.affiliation: Haseki Training and Research Hospital, Fatih, 34096, Istanbul, Turkey. bayerhan@yahoo.com.
authors.forename: Erhan
authors.initials: E
authors.lastname: Bayram
authors.affiliation: Dr. Lütfi Kırdar Kartal Training and Research Hospital, Semsi Denizer Cad. E5. Yanyol Cevizli Kavsagi, Kartal, 34890, Istanbul, Turkey. gcecen2002@yahoo.com.
authors.forename: Gultekin Sitki
authors.initials: GS
authors.lastname: Cecen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000671:Amputation, Surgical / Q000379:methods* / Q000523:psychology; D000673:Amputation, Traumatic / Q000523:psychology*; D001186:Artificial Limbs / Q000523:psychology; D003866:Depressive Disorder / Q000209:etiology*; D005260:Female; D005269:Femur / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D019736:Prostheses and Implants; D012189:Retrospective Studies; D057566:Self Report; D013977:Tibia / Q000601:surgery; D016896:Treatment Outcome
keywords: Amputation; HADS-A; HADS-D; K index