title: A "preamputation care pathway" reduces mortality for lower limb amputation.
abstract: Lower limb amputation due to peripheral arterial disease is common. The comorbid nature of this patient group makes management challenging. The aims of the study were 1) to introduce a novel "preamputation care pathway" to facilitate perioperative care and 2) to evaluate whether such a pathway is able to reduce morbidity and mortality. All patients undergoing lower limb amputation over 12 months were prospectively identified. Patient demographics were recorded before statistical analysis was performed. Twelve limbs were amputated (mean age, 69 years; mean American Association of Anesthesiologists score, 3.36). The mean time from presentation to amputation was 16.83 days. Eighty percent of patients were admitted to a critical care bed postoperatively. The mean time that patients stayed in a critical care environment was 2.62 days (range, 0-6 days). After a stay in the critical care unit, 90% of patients were stepped down to a health care of the elderly ward. One patient died in less than 30 days, representing a 10% 30-day mortality rate. The mean inpatient stay was 47 days (range, 19-121 days). Eighty percent of patients who underwent amputation in less than 10 days survived to discharge. In contrast, only 25% of patients who underwent amputation after day 11 survived to discharge (P = .0384). In conclusion, the implementation of the "preamputation care pathway" has reduced the 30-day mortality rate to 10%. A similar model of care currently exists for fractured neck of femur patients and is outlined by the care standards into "Best Practice Tariff" for the care of fractured neck of femur. A similar model should be implemented for patients undergoing lower limb amputation.
authors.affiliation: Department of Vascular Surgery, The Princess Alexandra Hospital, Harlow, United Kingdom. Electronic address: jason.lewis@doctors.org.uk.
authors.forename: Jason
authors.initials: J
authors.lastname: Lewis
authors.affiliation: Department of Vascular Surgery, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
authors.forename: Shiva
authors.initials: S
authors.lastname: Dindyal
authors.affiliation: Department of Vascular Surgery, The Princess Alexandra Hospital, Harlow, United Kingdom.
authors.forename: Hannah
authors.initials: H
authors.lastname: Raynor
authors.affiliation: Department of Vascular Surgery, The Princess Alexandra Hospital, Harlow, United Kingdom.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abidia
authors.affiliation: Department of Vascular Surgery, The Princess Alexandra Hospital, Harlow, United Kingdom.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Refson
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000009:adverse effects / Q000401:mortality; D015897:Comorbidity; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D019983:Guideline Adherence / Q000592:standards*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D035002:Lower Extremity / Q000098:blood supply; D008297:Male; D010351:Patient Discharge; D058729:Peripheral Arterial Disease / Q000150:complications; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome