Delay influences outcome after lower limb major amputation.

Abstract

AIM:

To investigate if a relationship exists between hospital waiting time to major amputation and outcome.

METHOD:

All patients undergoing major lower limb amputation in England between April 2002 and March 2006 were identified from the Hospital Episodes Statistics (HES) data. Amputations related to trauma or malignancy were excluded. The length of wait (LOW), from date of admission to date of major amputation was calculated. A two-level regression model was used to investigate if LOW had a significant effect on recovery time and in-hospital mortality. Results were adjusted for age, sex, Charlson score, Social Deprivation, mode of intervention (bypass/angioplasty/no intervention) and mode of admission (emergency/elective).

RESULTS:

14,168 major amputations were identified. 12,884 (90.9%) had no intervention prior to amputation on that admission. Length of Wait (LOW) significantly prolonged recovery in men (Exponential Estimate 1.01 1.01-1.02 p < 0.0001) and women (EE 1.02 1.01-1.02 p < 0.0001) and increased in-hospital mortality in men (OR 1.02 1.02-1.03 p < 0.0001). Risk of in-hospital death increased by 2% for each day waited.

CONCLUSION:

Delays in decision making or in getting a patient into the operating theatre have a negative effect on patient outcome in terms of overall length of stay and mortality after major lower limb amputation.

• Authors: P W Moxey, D Hofman, R J Hinchliffe, J Poloniecki, I M Loftus, M M Thompson, P J Holt
• Journal: European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery (Eur J Vasc Endovasc Surg) Vol. 44 Issue 5 Pg. 485-90 (Nov 2012) ISSN: 1532-2165 [Electronic] England
• PMID: 22967904 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Topics

• Aged
• Amputation, Surgical (adverse effects, mortality)
• Angioplasty
• England
• Female
• Hospital Mortality
• Hospitals (statistics & numerical data)
• Humans
• Length of Stay
• Limb Salvage
• Logistic Models
• Lower Extremity (blood supply)
• Male
• Multivariate Analysis
• Odds Ratio
• Patient Admission
• Risk Assessment
• Risk Factors
• Sex Factors
• Time Factors
• Time-to-Treatment (statistics & numerical data)
• Treatment Outcome
• Vascular Surgical Procedures