Functional Outcomes of Major Lower Limb Amputation 1994–2006: A Modern Series

In Brief To describe the outcomes with major lower limb amputation (LLA) in one institution in terms of morbidity, rehabilitation potential, discharge destination, and function. The medical records of all consecutive patients who underwent major LLAs at Prince of Wales Hospital between 1994 and 2006 were examined, and demographic and clinical data were extracted. Patients who had toe and partial foot amputations or multiple limb loss were excluded from this analysis. Ethical approval was obtained. During a 12-year period, 215 major LLAs were performed on 208 patients. This cohort consisted of 139 men (64.7%) and 76 women (35.3%). The average age was 70 years (SD ±15.5), with a range of 17 to 95 years. In this series of patients, 182 of them (85%) were single amputees and the remainder bilateral amputees (15%). Most amputations were performed for indications related to ischemia secondary to vascular insufficiency with or without diabetes (76.3%). Other indications included trauma (4.7%), infection (9.3%), and tumor (9.8%). The median length of stay in the acute ward was 32 days (mean 44 days, range 4–212 days). Significant wound infection (those requiring antibiotics) occurred in 64 (29.8%) amputations. Significant wound breakdown requiring reoperation occurred in 23%. Seven (3.3%) patients developed thromboembolism during hospitalization. The mortality rate during admission was 11.6%. Of the 190 patients who survived their acute admission, 135 patients (71%) were assessed by a rehabilitation physician to have rehabilitation potential. Fifty-five patients (29%) were transferred straight to nursing homes after medical stabilization without having rehabilitation. The subgroup selected for inpatient rehabilitation at Prince of Wales Hospital (n = 112) was further analyzed for their rehabilitation outcomes. The median length of stay in rehabilitation was 44 days (range 6–176 days). The outcomes of inpatient rehabilitation of amputees are very pleasing: 79% are able to be discharged home and 9% to a hostel; only 12% required nursing placement after a period of rehabilitation. In this group, 44% achieved community ambulation with a prosthesis, 20% achieved household ambulation with a prosthesis, and 12% used a prosthesis to transfer or exercise only. A total of 24% used only a wheelchair and they were unable to use a prosthesis. A total of 81% of the patients were prescribed a definitive prosthesis as part of their rehabilitation program. Major LLAs continue to give rise to extensive length of stay and perioperative morbidity and mortality in the patient population with peripheral vascular disease as the major indication for such operation. Approximately one third have no rehabilitation potential postamputation. Those who are accepted into rehabilitation do well in terms of their functional outcomes, with the majority achieving independent mobility and self-care. This review of major lower limb amputation outcomes demonstrated that these amputations continue to give rise to extensive length of stay and perioperative morbidity and mortality. Nearly one-third had no rehabilitation potential postamputation. Those that are accepted into rehabilitation did well in terms of their functional outcomes. All of these measures can enhance our knowledge in providing better resource allocation and better quality of care to patients as well as providing counseling to them pre- and post-operatively.