What if that amputation wasn’t necessary?

Expert advisers thought that 7.3% of the cases they reviewed had had unnecessary amputations. Revascularisation or conservative management was thought to have been more appropriate.

The National Confidential Enquiry in to Patient Outcome and Death looked at 479 cases in England and Wales in 2014.  They considered that only 44% of patients who had amputations for vascular or diabetes had received care in accordance with recommended standards published in the Vascular Society’s Quality Improvement Framework for Major Amputation Surgery.

Amputations can become necessary for a variety of reasons: severe trauma, sudden artery blockage, or sudden overwhelming infection for instance.  But for many diabetic and vascular patients the damage is insidious, and treatment to reverse damage can be effective if done early enough.  At the end of months or years of unsuccessful interventions sometimes amputation gives relief from unrelenting pain or infection, mobility can be restored, and a better quality of life can begin again.

The UK mortality rates for people undergoing the operations was 12.4% compared to the USA’s 9.6% for a similar group of patients.

A major problem was that the co-ordinated multi-disciplinary care that is needed to divert patients away from amputation and for successful rehabilitation after amputation is not always in place. A Leeds vascular consultant, Michael Gough said, “patients need treatment of diabetes and heart problems, physiotherapy, rehabilitation and a properly planned discharge”.

In my own area, the multi-disciplinary teams are not in place to reliably prevent amputations nor to give smooth discharge home and rehabilitation afterwards. It is bad enough to struggle at home after an amputation but truly devastating to think that something far less final could have been attempted.

Based on BMJ article by Susan Mayor 15 Nov 2014.

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