Lower extremity amputation protocol: a pilot enhanced recovery pathway for vascular amputees

Area of Science:

• Vascular Surgery
• Rehabilitation Medicine
• Health Services Research

Background:

• Vascular patients constitute over 80% of major lower extremity amputations in the US, often being older and frail.
• Early physical therapy and acute rehabilitation are associated with decreased postoperative length of stay (LOS) and expedited ambulation.
• The effectiveness of a standardized protocol for perioperative care in vascular amputees requires further investigation.

Purpose of the Study:

• To determine if the Lower Extremity Amputation Protocol (LEAP) improves outcomes for vascular patients undergoing major lower extremity amputation.
• To compare postoperative length of stay, time to prosthesis receipt, and time to ambulation between LEAP patients and historical controls.
• To assess the impact of a multidisciplinary, protocol-driven approach on patient recovery and healthcare utilization.

Main Methods:

• A nonrandomized prospective study comparing vascular patients treated with LEAP (n=11) to historical controls (n=130) from January 2019 to February 2020.
• Exclusion criteria included nonambulatory status or prior contralateral major amputation.
• LEAP involved a multidisciplinary team and a standardized perioperative care protocol.

Main Results:

• LEAP patients had a significantly shorter postoperative LOS (3 vs. 6 days; P < .001) and received physical therapy sooner (P = .006).
• LEAP patients were more likely to be discharged to acute rehabilitation (100% vs. 27%; P < .001), receive a prosthesis (100% vs. 45%; P < .001), and ambulate with it (100% vs. 43%; P < .001).
• Time to prosthesis receipt (81 vs. 137 days; P = .002) and ambulation (86 vs. 146 days; P = .002) were significantly reduced with LEAP. No differences in surgical complications or readmissions were observed.

Conclusions:

• The LEAP protocol significantly decreases postoperative LOS and expedites ambulation with a prosthesis for vascular patients undergoing lower extremity amputation.
• This standardized, multidisciplinary approach shows promise in improving care and bridging healthcare gaps for a high-risk, diverse patient population.
• LEAP offers a structured method to enhance recovery and functional outcomes following major lower extremity amputations.