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Characteristics of Patients Admitted to Vascular Surgery Service for a Major Lower Limb Amputation From 2017 to 2021
Catherine R Ratliff1,2, Virginia Rovnyak1,2
1Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFCN, FAAN, Department of Surgery, University of Virginia Health, Charlottesville, Virginia.
Purpose:
The purpose of this study was to describe characteristics of patients admitted from 2017 to 2021 with peripheral arterial disease (PAD) who required a below knee amputation (BKA) or above knee amputation (AKA), including present on admission pressure injuries (POA-PIs).
Design:
Descriptive, cross-sectional retrospective research design.
Subjects And Setting:
The sample comprised 196 patients who underwent 258 major lower limb amputations. A majority (65.9 %n = 170) underwent BKAs and 88 (34.1 %) underwent AKAs. Coronary artery disease was present in 107 (54.6 %) and 143 (73.0%) had diabetes mellitus. The study site was a 670-bed level 1 trauma center in the Mid-Atlantic region of the United States.
Methods:
A retrospective chart review of patients undergoing major lower limb amputations using CPT codes 27880 BKA, and 27590 AKA was completed. Variables extracted included age, sex, race, and comorbid conditions such as smoking, cardiovascular disease, diabetes mellitus, end stage renal disease requiring dialysis, and POA-PI. Descriptive statistics (frequencies, percentages, and means) were used to describe the sample.
Results:
There were 25 (12.8%) individuals with POA-PI compared with 171 (87.2%) who did not have POA-PI. None of the characteristics reviewed significantly differed when patients with or without POA-PI were compared. Age was closest to statistical significance ( P = .052). In addition, analysis revealed that 73% (n = 143) of individuals had diabetes mellitus in addition to having PAD.
Conclusion:
Approximately 13% of a group of patients with PAD had POA-PI when admitted to hospital for major limb amputation. Analysis of multiple factors found that none significantly differed between patients with or without POA-PI. Age came nearest to statistical significance and we hypothesize that older age may increase the risk for POA-PI; additional research in samples with greater power to detect this effect are needed. Findings also indicate that diabetes mellitus is a common risk factor for major lower limb amputation. It is important to educate staff/patients/caregivers on the importance of PI prevention especially in the elderly vascular population who are at risk for undergoing major lower limb amputations.
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