Lower Limb Amputee Patients Have Comorbidities and Risk of Complications - Findings from a Hospital Audit

Background: Lower limb amputee patients tend to have multiple co-morbidities and are at risk of developing complications during early rehabilitation for lower limb amputees. These complications are associated with worse outcomes and interruption in rehabilitation, requiring a transfer from the rehabilitation ward to acute medical or surgical care. This study aims to describe the circumstances of patients transferred from early lower limb amputee rehabilitation ward to regional hospitals, and identify areas of potential improvement in management. Methods: The present study is a retrospective study of electronic records for patients admitted or transferred to Hutt Hospital from vascular surgery wards for early lower limb amputee rehabilitation between 1st January 2009 and 31st December 2011. The data collected was identified through a multidisciplinary discussion to determine appropriate standards of care for amputee patients. This included patient demographics, comorbidities, cognitive and physical function, as well as complications during rehabilitation. Results: There were 42 lower limb amputations with median age of patients 71.5 years. Dysvascularity was the most common cause (57.1%) for amputation. Patient care was inappropriately stepped-down to a rehabilitation ward, including one in six amputees who were not haemodynamically stable, and onequarter of patients with hypoglycaemia. Handover between allied health staff and comprehensive assessment, particularly of the contralateral limb should be improved. Complications during rehabilitation involved 71.4% patients, the most common non-wound issues were decubitus ulcers, chest infections and delirium. A quarter of the patients, initially living at home were discharged to residential care. The median length of hospital stay was 44.5 days. Conclusions: Amputee patients have multiple co-morbidities and a high risk of complications. The areas of improvement identified included transfer of care between allied health professionals, appropriateness of step-down transfer to rehabilitation, assessment of the contra-lateral limb and standardisation of care. Education of healthcare professionals and systematic transfer of care should be implemented for patients transferred for early rehabilitation for lower limb amputees.