Short summary

Patients receiving femur/crus amputation are multifaceted and the presence of comorbidities like diabetes, cardiovascular- and neurological diseases complicates the treatment of these patients.

However, in a recent Danish study, improved treatment and care reduced the 30-day post-operative mortality by 52% and the 1- year post-operative mortality by 46% compared with controls. The intervention consisted of several aspects including; use of expert teams, fluid therapy, blood transfusion, early mobilization and training. An American study reduced admission time by 8 days following a coordinated multi-disciplinary intervention. Dutch evidence-based guidelines recommend the use of senior surgeons, postoperative compression treatment, optimal pain management and collaboration in multi-disciplinary teams. Collectively, these studies show more evidence for treatment of amputees is needed and a systematic approach to treatment and care warranted.

Aim: The study aim is to investigate if time in hospital for patients with thigh or lower leg amputation (femur/crus) can be reduced by optimizing the admission process

Impact: Knowledge to support optimum treatment and care of amputees is lacking and the current study will hopefully provide evidence for two interventions which can be utilized nationally and internationally. The results will be presented at the Danish Foot and Ankle Society and at the Professional Society of Orthopedic Nurses Conference.

Rationale

Description of the cohort

The study consists of three phases: 

Phase one, retrospective collection of demographic characteristics and treatment of amputees admitted within the past two years. 

Phase two, identify potential and current intervention strategies

Phase three, intervention and evaluation of the effect of two specific treatment strategies. During phase three, patients with femur or crus amputation submitted to Orthopedic Department at Kolding Hospital will consecutively be included. 

Data and biological material

A wide range of demographic data (age, gender, comorbidities, surgical treatment, complications, days in hospital, postoperative rehabilitation, fluid therapy, transfusions ect.)will be collected during a medical audit. Then, 30-day readmission and 30-day mortality rates are calculated. Potential effective interventions identified by literature review combined with current treatment strategies are assessed in terms of applicability within the framework of our department and the potential effect on hospitalization.   

Collaborating researchers and departments

Department of Orthopedic Surgery Department, Hospital Lillebælt, Kolding

• Physician Hanne Metha Pop
• Quality Manager Dorte Dall-Hansen
• Nurse Hanne Vase
• Physician Finn Thamdrup
• Nurse Jeanette Lorentzen
• Associate Professor Carsten Jensen, PhD