Quality improvement framework for major amputation: are we getting it right?
Article first published online: 20 NOV 2012
© 2012 Blackwell Publishing Ltd
International Journal of Clinical Practice
Volume 66, Issue 12, pages 1230–1234, December 2012
How to Cite
Krysa, J., Fraser, S., Saha, P., Fuller, M., Bell, R. E., Carrell, T. W. G., Modarai, B., Taylor, P. R. and Zayed, H. A. (2012), Quality improvement framework for major amputation: are we getting it right?. International Journal of Clinical Practice, 66: 1230–1234. doi: 10.1111/j.1742-1241.2012.02905.x
Linked Comment: http://www.youtube.com/IJCPeditorial
- Issue published online: 20 NOV 2012
- Article first published online: 20 NOV 2012
- Paper received November 2011, accepted February 2012
Introduction: The quality improvement framework for major amputation was developed with the aim of improving outcomes and reducing the perioperartive mortality to less than 5% by 2015. The aim of the study was to assess our compliance with the framework guidelines and look for the reasons for non-compliance.
Method: All major amputations performed between 2008 and 2010 were included. The following data were collected: presence of infection ± tissue loss, status of arterial supply, revascularisation attempts, time to surgery, type of amputation, morbidity and mortality.
Results: A total of 81 patients were included (42 BKAs, 39 AKAs). Ninety percentage had formal preoperative arterial investigations and 84% had an attempted revascularisation procedure. Patients who were transferred late from non-vascular units (n = 12) had a 30-day mortality of 50% whereas patients who presented directly to our unit had a 30-day mortality of 7.2%. The number of amputations has decreased over the last 3 years from 34 to 21 per year, coinciding with the doubling of crural revascularisation procedures performed (from 60 to 120 per year). Ten patients underwent a revision from BKA to AKA because of an inadequate profunda femoris artery (PFA), whereas all those with a healed BKA stump either had a good PFA or a named crural vessel.
Conclusion: The overall number of amputations is decreasing from year to year. By doubling our crural revascularisation procedures we are saving more limbs. Thirty-day mortality is higher than expected, particularly in patients who present late. Expeditious referral may potentially improve the mortality rate among this group of patients.