The characteristics and outcomes of lower limb amputations at Moi Teaching and Referral Hospital, Eldoret

Abstract

Background: Major limb amputation is a big but preventable public health problem. It is associated with profound economic, social and psychological effects on the patient and family especially in developing countries where prosthetic services are poor. Indications include trauma, infections, tumors and peripheral vascular diseases which are modifiable. Limb salvage surgeries are not well developed in our setting. Even in centers with limb revascularization, major amputations are still done. In MTRH, there is paucity of knowledge about the outcome of amputation, discharge destination, prosthesis use, rehabilitation and follow-up of these amputees. Objective: To determine the characteristics and outcomes of lower limb amputations among patients presenting to MTRH. Methodology: This was a descriptive prospective study conducted at MTRH orthopaedics and surgical wards and clinics. Study population were patients who underwent lower limb amputation. Only patients from whom written informed consent was obtained were enrolled. Consecutive sampling was used. Interviewer administered questionnaire was used to collect socio-demographic and clinical findings and outcomes at admission and on discharge. Data obtained was analyzed using SPSS, version 20. Chi-square and t-test were used for comparison of variables. Results: A total of 85 patients participated in the study with age ranging from 3months to 97 years and a mean age of 49.6 (SD 23.8). Males were 56 (65.9%) while females were 29 (34.1%) (male to female ratio of 1.9:1). Forty two (49.4%) of the patients were aged between 40-69 years. Transfemoral amputations constituted 37 (43.5%) while 31 (36.5%) were transtibial amputation. Forty two (51%) amputations were done on the left. Diabetes was the predominant comorbidity in 26 (51%) patients. Vascular etiology constituted 44 (48%) patients while trauma had 20 (23.5%) and tumors 8 (9.4%). Patients with vascular indications were older compared to the rest. Surgical site infection was the main complication in 26 (52%) of the 50 subjects that developed complications. Decision to amputate was made by the consultant surgeon in 62 (73%) patients. Sixty-seven (79%) patients had a discussion on prosthesis use and type with their surgeon but only 6 (7.1%) were reviewed by prosthesis officers. Five patients (5.9%) died. Conclusion: Peripheral vascular disease was the prevalent indication for amputation. Transfemoral amputation was the commonest level of amputation done. Diabetes mellitus was the predominant comorbidity and surgical site infection was the commonest complication. Recommendations: Preventive measures be instituted to reduce the burden of vasculopathy and surgical complications. Strengthening of domiciliary prosthesis services should be done. Limitations: Surgeries were performed by different surgeons with varying levels of experience which could have had an impact on outcomes