In Denmark, approximately 1800 major lower extremity amputations are performed yearly, defined by amputation above the ankle and divided in: hip disarticulation, transfemoral amputation, knee disarticulation, transtibial amputation and hip disarticulation. Amputation procedures are common, but the area lacks evidence-based practice. At Odense University Hospital, approximately 200 major amputations and re-amputations are performed annually, and were in 2018 the hospital in Denmark that performed most major lower extremity amputations. Primary transfemoral amputation is the most frequent type, accounting for approximately 100 (50%) of the amputation procedures, and rising.
A proper description of the patient and statement of risk factors for postoperative complications are essential tools to improve outcome after major lower extremity amputation, and patients represent a frail group with extensive comorbidity.
The overall aim of this PhD-thesis is to examine the demographics, postoperative outcome by evaluating the risk of complications, and health related quality of life. Finally, possibilities for improvement of treatment are investigated as a randomized controlled trial.
In the first registry study demographics and trends are investigated.
- To investigate demographic changes in patients undergoing major lower extremity amputation in Denmark.
- To explore the distribution of diabetes, prior vascular surgery, arteriosclerosis and renal insufficiency among major LEA patients.
- To examine the amount of patients having more than one major amputation (either same side or other side)
- The trend between the different amputation levels on the lower extremity.
In the second registry study the patient safety is compared to a control group of hip fractures
- To examine postoperative length of hospital stay, risk of readmission (≤90 days), risk of reoperation and mortality, compared to a control group of hip-fracture patients.
The aim of the randomized controlled trial is to investigate to investigate the total blood loss and secondary to investigate differences in complications after transfemoral amputation between patients operated with or without tourniquet. The hypothesis is that use of tourniquet will reduce the total blood loss and improve patient safety. Based on a pilot series, the sample size was calculated to 124, allocated 1:1 in two groups of 62 participants to ensure detection of at least 200 mL difference in the total blood loss.