Quality of care using nursing-sensitive indicators in major lower extremity amputation patients: Insights from the XX KOhort (KOKO) database

Aim To describe the structure and content of the population-based KOKO database and to report demographics and quality of care, assessed by nursing-sensitive indicators, in patients with major lower extremity amputation from 2019–2022. Design A cross-sectional study. Methods The XX KOhort (KOKO) database was established in 2019 to register patients undergoing initial major lower extremity amputation and includes data on quality indicators and prognostic variables. Quality of nursing care was assessed using indicators related to the musculoskeletal system, skin integrity, pain, nutrition, and elimination. Moreover, data on postoperative complications, 30-day readmission and mortality were collected. All data were prospectively extracted from medical records. Results The cohort comprised 225 patients (62% men; median age 72 years); 54% lived alone. Trans-femoral amputations accounted for 75% of procedures. Pressure ulcer screening was performed in 88%, and 55% received air mattress support. Weight was recorded in 85% at admission, 46% post-amputation, and 44% at discharge. Across postoperative day 1-3, 50–53% of patients were mobilized to a chair. Sufficient stump healing was observed in 50% by day 5 and 57% at discharge. Nearly half reported "no to mild pain" at two time points. Nutritional targets for energy and protein were calculated in 47% and 45% of patients, respectively. Infections (36%) and constipation (28%) were common complications; in-hospital mortality was 7%. Conclusion This study provides the first systematic overview of quality of care among patients undergoing major lower extremity amputation using nursing-sensitive indicators. While strengths were identified, gaps remain in pain management, wound care, and nutrition.