PATTERNS AND INDICATIONS OF AMPUTATION IN CAPE COAST TEACHING HOSPITAL: A FOUR YEAR RETROSPECTIVE REVIEW

Limb amputation is reported to be a major but preventable public health problem that is associated with profound economic, social and psychological effects on the patient and family especially in developing countries where prosthetic services are unavailable, inaccessible or unaffordable.

The purpose of this study was to determine the patterns of and indications for limb amputations.

A retrospective study, covering a 4-year period, involving 126 patients who underwent amputation at a teaching hospital was carried out. Data on patients including indication for amputation were obtained from theatre record books and folders and analyzed using SPSS and MS Excel. Data was presented in frequencies and percentages. Chi square tests were used to compare categorical variables and differences were considered significant if p<0.05.

The mean age of the 126 patients was 60.92(SD19.03) years with a median of 67years. There were 68 females and 58 males giving a female to male ratio of 1.2:1. Lower limb amputations were performed in 114(90.48%) and upper limb amputations in 12(9.52%) patients. The commonest indication for amputation was diabetic foot gangrene accounting for 54(42.86%) patients, followed by peripheral vascular disease 43(34.13%) and trauma 12(9.52%). Twenty-one of the patients who had amputations for indications other than diabetic foot gangrene also had diabetes mellitus. Below knee amputation was the commonest procedure performed (43.65%). One hundred and twenty (95.2%) were unilateral and 116 (92.1% ) were performed in a single-stage procedure.

Most of the amputations in the Cape Coast Teaching Hospital were performed in elderly patients, with a slight preponderance of women over men. Lower limb amputations were far more common than upper limb ones. The commonest indication for amputations was diabetic foot gangrene, with below knee amputation being the commonest type. There is an urgent need for public education on diabetes and its complications and on diabetic foot care. The establishment of a multidisciplinary diabetic foot care clinic is advocated if the incidence of limb amputations is to be reduced in the Cape Coast Teaching Hospital.