More than 5,000 people in England, Wales and Northern Ireland undergo a major amputation each year, but 56% of amputees do not receive good care, according to a report from the National Confidential Enquiry into Patient Outcome and Death.
More than half of patients included in the study also had diabetes, but researchers found there had been little involvement in their care by diabetes specialists, according to the report. Additionally the mortality rate for amputations was found to be 12.4%, as compared with 9.6% in the United States.
Key findings from the report include:
- Early review from a consultant vascular surgeon might have changed the outcome for 18 of 198 patients.
- Of patients who should have had elective amputation surgery, 23% underwent emergency surgery.
- A planned operating list would have allowed two-thirds of delays to be avoided.
- Overall, 87% of amputees did not have a named individual responsible for coordinating their discharge and rehabilitation.
- Of the patients with diabetes, 12% were admitted under the care of diabetes service and 58% were reviewed before operation by a diabetes nurse specialist.
- Glycemic control was poor or unacceptable in at least one in seven patients in at least one point within the surgical pathway.
“Having a limb removed is a life-changing experience and patients need to be supported by a wide range of health professionals other than just the surgeon,” Michael Gough, ChM, FRCS, lead report author and consultant vascular surgeon, stated in a press release. “Good multidisciplinary care from the outset is require to ensure that these patients, who often have multiple medical problems, receive the best possible treatment, including treatment of diabetes and heart problems, physiotherapy, rehabilitation and a properly planned discharge.”
Bertie Leigh, National Confidential Enquiry into Patient Outcome and Death (NCEPOD) chair, added, “Our advisors found room for improvement in every aspect of both the organization and clinical delivery of care to patients having amputation.”
Recommendations from the NCEPOD include the development of a best practice clinical care pathway; preoperative review of all diabetic patients; preoperative review of patients with limb-threatening ischemia by a vascular surgeon; a planned operating list for amputations; a policy that requires amputations to be carried out within 48 hours of decision to operate; and discharge planning which commences as soon as need for amputation is identified, with a suitably qualified amputation or discharge coordinator assigned to the patient.
For more information:
Gough M. Lower Limb Amputation: Working Together. Available at www.ncepod.org.uk/2014lla.htm. Accessed Nov. 17, 2014.
Disclosure: NCEPOD is an independent charitable organization that reviews medical and surgical clinical practice and makes recommendations to improve the quality of the delivery of care. This study was undertaken as part of the Clinical Outcome Review Programme into Medical and Surgical Care commissioned by the Healthcare Quality Improvement Partnership.