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Comment
. 2016 Jun;87(3):306-11.
doi: 10.3109/17453674.2016.1167524. Epub 2016 Apr 18.

An enhanced treatment program with markedly reduced mortality after a transtibial or higher non-traumatic lower extremity amputation

Morten T Kristensen  1   2 , Gitte Holm  2 , Michael Krasheninnikoff  2 , Pia S Jensen  2   3 , Peter Gebuhr  2
Affiliations
Comment

An enhanced treatment program with markedly reduced mortality after a transtibial or higher non-traumatic lower extremity amputation

Morten T Kristensen et al. Acta Orthop. 2016 Jun.

Abstract

Background and purpose - Historically, high 30-day and 1-year mortality post-amputation rates (> 30% and 50%, respectively) have been reported in patients with a transtibial or higher non-traumatic lower extremity amputation (LEA). We evaluated whether allocating experienced staff and implementing an enhanced, multidisciplinary recovery program would reduce the mortality rates. We also determined factors that influenced mortality rates. Patients and methods - 129 patients with a LEA were consecutively included over a 2-year period, and followed after admission to an acute orthopedic ward. Mortality was compared with historical and concurrent national controls in Denmark. Results - The 30-day and 1-year mortality rates were 16% and 37%, respectively, in the intervention group, as compared to 35% and 59% in the historical control group treated in the same orthopedic ward. Cox proportional harzards models adjusted for age, sex, residential and health status, the disease that caused the amputation, and the index amputation level showed that 30-day and 1-year mortality risk was reduced by 52% (HR =0.48, 95% CI: 0.25-0.91) and by 46% (HR =0.54, 95% CI: 0.35-0.86), respectively, in the intervention group. The risk of death was increased for patients living in a nursing home, for patients with a bilateral LEA, and for patients with low health status. Interpretation - With similarly frail patient groups and instituting an enhanced program for patients after LEA, the risks of death by 30 days and by 1 year after LEA were markedly reduced after allocating staff with expertise.

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Figures

Figure 1.
Figure 1.
Flow chart of amputee patients at Hvidovre Hospital, from 2010 to 2012.
Figure 2.
Figure 2.
Kaplan-Meier graphs of 30-day (left panel) and 1-year (right panel) post-amputation survival of the control and intervention groups.
Figure 3.
Figure 3.
Kaplan-Meier graphs of 30-day survival according to age group (panel A), residential status (B), American Society of Anesthesiologists score (C), and index amputation level (D).
See this image and copyright information in PMC

Comment on

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