Benefits of an Enhanced Recovery Pathway for Lower Extremity Amputation Patients

Area of Science:

• Surgical outcomes research
• Patient recovery protocols
• Amputation care management

Background:

• Enhanced Recovery Programs (ERPs) utilize interdisciplinary collaboration, patient education, multimodal pain control, and early mobilization.
• ERPs show potential to improve care for patients undergoing lower extremity amputation (LEA).

Purpose of the Study:

• To evaluate the impact of ERPs on outcomes for patients undergoing major LEA.
• To compare outcomes between patients receiving ERP care and a historical pre-ERP cohort.

Main Methods:

• Retrospective cohort study comparing ERP patients (02/2022-07/2023) with a pre-ERP cohort (01/2020-01/2022).
• Analysis of length of stay (LOS), perioperative complications, time to prosthetic receipt, and achieved K-level ambulation.
• Subgroup analysis for staged procedures, below-knee amputation (BKA), and above-knee amputation (AKA).

Main Results:

• ERP patients experienced fewer 30-day readmissions and 90-day complications, particularly those undergoing staged procedures.
• ERP below-knee amputation (BKA) patients showed reduced 90-day mortality (2.5% vs. 12.2%).
• ERP above-knee amputation (AKA) patients had a shorter LOS (6 vs. 7 days), and the overall ERP cohort had faster prosthetic receipt (176 vs. 226 days).

Conclusions:

• ERP implementation is associated with improved outcomes, including reduced complications and readmissions for LEA patients.
• Faster prosthetic receipt in ERP patients is crucial, given the link between ambulation and improved survival.
• The significant comorbidities in LEA patients underscore the value of ERP-centered optimization strategies.