Characterization of a Portuguese Major Amputee Population: 5 Years of a Physical and Rehabilitation Medicine Amputee Unit
DOI :
https://doi.org/10.25759/spmfr.487Mots-clés :
Amputees/rehabilitation, Amputation, Surgical, Amputation, Traumatic, Artificial Limbs, Portugal, Rehabilitation CentersRésumé
Introduction: Knowledge of the amputee population is relevant for health care planning, namely rehabilitation services and demand for prosthetic devices. In Portugal, there is not enough knowledge concerning these data. We aim to characterize a sample of five-year cases from an Amputee Physical and Rehabilitation Medicine Unit of a Portuguese Tertiary Hospital.Methods: All records from 2015-2020, were reviewed. Only major limb amputees were included. Descriptive and subgroup analysis was performed.
Results: From 737 patients, 620 were included. The majority (69%) were men, with an average age of 55.5 ± 20.5 years at the time of their first major amputation. Amputation level wasJtranstibial (TT) in 53%, transfemoral (TF) in 43%, with hip disarticulation, transradial, transhumeral and shoulder disarticulation ranging from 0:2% - 1.6%. The most common causes were dysvascular (64%) and traumatic (18%). Four out of 5 hip disarticulations were due to malignancy. JMore than half (54%) of vascular amputees were followed in the Diabetic Foot Clinic. The major re-amputation rate was 14%, including proximal and contralateral [10% for TF, 16% for TP]. The time between first major amputation and re-amputation was 1.6 ± 2.4 years.J Overall mortality was 24%: 38% of deaths occurred in the first year and 76% in 5-years. Considering only vascular causes, mortality rose to 33% and re-amputation in first year was 20%. Prosthetics attribution rates were 77%-90% for unilateral lower limb (LL) amputees and 73% for upper limb amputees. Bilateral LL amputees (n=70) were BiTF, BiTT and TF+TT, with 5%, 84% and 63% prosthetics rates, respectively. Traumatic amputations had the highest prosthetics rate (96%). In total, 78 patients did not fulfill the criteria to initiate prothetization, among the stated reasons were bilateral amputation, balance or contralateral limb alterations and neurologic disturbances.
Conclusion: We managed to achieve a characterization of a large case series of an Amputee population followed in a PRM Unit of a Portuguese Universitary General Hospital, focusing on the cause, level of amputation, re-amputation, prosthetics and mortality rates. This sample may contribute to a better knowledge of our amputee population, allowing for an improved approach to their medical care process and consequently a better-quality Amputee Rehabilitation.
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Machado Vaz I, Roque V, Pimentel S, Rocha A, Duro H. Psychosocial Characterization of a Portuguese Lower Limb Amputee Population. Acta Médica Portuguesa. 2012;25(2):77-82.
Glaser JD, Bensley RP, Hurks R, Dahlberg S, Hamdan AD, Wyers MC, et al. Fate of the contralateral limb after lower extremity amputation. J Vasc Surg. 2013;58(6):1571-7.e1.
Sumiya A. Satisfação com a saúde e capacidade funcional de idosos amputados. Neurobiologia. 2009;72(2):43-50.
Fard B, Dijkstra PU, Voesten H, Geertzen JHB. Mortality, Reamputation, and Preoperative Comorbidities in Patients Undergoing Dysvascular Lower Limb Amputation. Ann Vasc Surg. 2020;64:228-38.
Dillingham TR, Pezzin LE, Shore AD. Reamputation, mortality, and health care costs among persons with dysvascular lower-limb amputations. Arch Phys Med Rehabil. 2005;86(3):480-6.
Fang ZB, Hu FY, Arya S, Gillespie TW, Rajani RR. Preoperative frailty is predictive of complications after major lower extremity amputation. J Vasc Surg. 2017;65(3):804-11.
Chahrour MA, Homsi M, Wehbe MR, Hmedeh C, Hoballah JJ, Haddad FF. Major lower extremity amputations in a developing country: 10-Year experience at a tertiary medical center. Vascular. 2021;29(4):574-81.
Isaacs-Itua A, Sedki I. Management of lower limb amputations. Br J Hosp Med (Lond). 2018;79(4):205-10.
United National Institute for Prosthetics & Orthotics Development. UK limbless population referred for prosthetics treatment: 2011-2012. University of Salford. 2015.
Stern JR, Wong CK, Yerovinkina M, Spindler SJ, See AS, Panjaki S, et al. A Meta-analysis of Long-term Mortality and Associated Risk Factors following Lower Extremity Amputation. Ann Vasc Surg. 2017;42:322-7.
Kröger K, Berg C, Santosa F, Malyar N, Reinecke H. Lower Limb Amputation in Germany. Dtsch Arztebl Int. 2017;114(7):130-6.
Silbernagel G, Rein P, Saely CH, Engelberger RP, Willenberg T, Do DD, et al. Prevalence of type 2 diabetes is higher in peripheral artery disease than in coronary artery disease patients. Diab Vasc Dis Res. 2015;12(2):146-9.
Lange S, Diehm C, Darius H, Haberl R, Allenberg JR, Pittrow D, et al. High prevalence of peripheral arterial disease and low treatment rates in elderly primary care patients with diabetes. Exp Clin Endocrinol Diabetes. 2004;112(10):566-73.
NHS Digital. National Diabetes Foot Care Audit Hospital Admissions. Report 2014-2016. https://digital.nhs.uk/data-and-information/publications/statistical/national-diabetes-footcare-audit/national-diabetes-foot-care-audit-2014-2016 [accessed 20 January 2022]
Kristensen MT, Holm G, Kirketerp-Møller K, Krasheninnikoff M, Gebuhr P. Very low survival rates after non-traumatic lower limb amputation in a consecutive series: what to do? Interact Cardiovasc Thorac Surg. 2012;14(5):543-7.
Layden J, Michaels J, Bermingham S, Higgins B. Diagnosis and management of lower limb peripheral arterial disease: summary of NICE guidance. Bmj. 2012;345:e4947.
Schaper NC, van Netten JJ, Apelqvist J, Bus SA, Hinchliffe RJ, Lipsky BA. Practical Guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update). Diabetes Metab Res Rev. 2020;36 Suppl 1:e3266.
Wukich DK, Raspovic KM, Suder NC. Patients With Diabetic Foot Disease Fear Major Lower-Extremity Amputation More Than Death. Foot Ankle Spec. 2018;11(1):17-21.
Ratliff HT, Shibuya N, Jupiter DC. Minor vs. major leg amputation in adults with diabetes: Six-month readmissions, reamputations, and complications. J Diabetes Complications. 2021;35(5):107886.
Sager MA, Rudberg MA, Jalaluddin M, Franke T, Inouye SK, Landefeld CS, et al. Hospital admission risk profile (HARP): identifying older patients at risk for functional decline following acute medical illness and hospitalization. J Am Geriatr Soc. 1996;44(3):251-7.
Lopez-de-Andres A, Jiménez-García R, Aragón-Sánchez J, Jiménez-Trujillo I, Hernández-Barrera V, Méndez-Bailón M, et al. National trends in incidence and outcomes in lower extremity amputations in people with and without diabetes in Spain, 2001-2012. Diabetes Res Clin Pract. 2015;108(3):499-507.
Horta C, Vilaverde J, Mendes P, Gonçalves I, Serra L, Pinto P, et al. Avaliação da Taxa de Amputações, Consulta Multidisciplinar do Pé Diabético. Acta Médica Portuguesa. 2003;16:373-80.
Steward C, Trimmings N. Synopsis of causation. Lower limb amputation. https://www.gov.uk/government/publications/synopsis-of-causation-amputation-of-the-lower-limb [accessed 21 December 2021]
Salminger S, Stino H, Pichler LH, Gstoettner C, Sturma A, Mayer JA, et al. Current rates of prosthetic usage in upper-limb amputees – have innovations had an impact on device acceptance? Disability and Rehabilitation. 2022;44(14):3708-13.
Rosario FM, Fernandez MA, Bravo AM, Álamo MN, Enríquez JS, editors. Manual de Rehabilitación y Medicina Física. 1st ed. Online: SOCARMEF; 2017.
Sauter CN, Pezzin LE, Dillingham TR. Functional outcomes of persons who underwent dysvascular lower extremity amputations: effect of postacute rehabilitation setting. Am J Phys Med Rehabil. 2013;92(4):287-96.
van Eijk MS, van der Linde H, Buijck B, Geurts A, Zuidema S, Koopmans R. Predicting prosthetic use in elderly patients after major lower limb amputation. Prosthet Orthot Int. 2012;36(1):45-52.
Bedoya MA, Chauvin NA, Jaramillo D, Davidson R, Horn BD, Ho-Fung V. Common Patterns of Congenital Lower Extremity Shortening: Diagnosis, Classification, and Follow-up. Radiographics. 2015;35(4):1191-207.
Norvell DC, Czerniecki JM. Risks and Risk Factors for Ipsilateral Re-Amputation in the First Year Following First Major Unilateral Dysvascular Amputation. Eur J Vasc Endovasc Surg. 2020;60(4):614-21.
Thorud JC, Plemmons B, Buckley CJ, Shibuya N, Jupiter DC. Mortality After Nontraumatic Major Amputation Among Patients With Diabetes and Peripheral Vascular Disease: A Systematic Review. J Foot Ankle Surg. 2016;55(3):591-9.
Meier RH, 3rd, Melton D. Ideal functional outcomes for amputation levels. Phys Med Rehabil Clin N Am. 2014;25(1):199-212.
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