Literature analysis of complications and predictive factors of amputees during postoperative hospitalization_West China Medical Journal

Authors：

LIN Meng ^1,2 , ZHANG Yaqing ³ , YANG Fan ⁴ , YAN Dirui ⁵ , SU Fenghua ⁶ ,  LI Sijian ⁷

1. Department of Pediatric Genetics, Metabolism and Endocrinology Nursing, West China Second University Hospital, Sichuan University / West China School of Nursing, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, P. R. China;
3. Department of Orthopaedics, Mianyang Central Hospital, Mianyang, Sichuan 621000, P. R. China;
4. Department of Neurointensive Care Unit, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
5. Department of Newborn, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
6. Department of Emergency Intensive Care Unit, Fujian Provincial Hospital, Fuzhou, Fujian 350001, P. R. China;
7. School of Nursing, the Hong Kong Polytechnic University, Hong Kong 999077, P. R. China;

Corresponding author：

LI Sijian, Email: si.jian.li@polyu.edu.hk

Keywords：

Amputee; complications; predictive factors; bibliometrics

DOI：

10.7507/1002-0179.202003423

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Objective To analyze the major complications and predictive factors of amputees during postoperative hospitalization, and provide a reference for amputees nursing and early rehabilitation. Methods Using the bibliometric method, we searched Embase, Ovid, Medline, PubMed, CINAHL, China National Knowledge Infrastructure, Wanfang and CQVIP databases for the data of postoperative hospitalization of amputees published from January 1st, 2008 to April 5th, 2022. Statistical description and analysis of article types, sample size, reasons for amputation, amputation sites, complications, influencing factors, predictive factors, and treatment recommendations were performed.Results Finally, 19 articles were included, including 16 in English and 3 in Chinese, all of which were quantitative studies. The literature quality scores were greater than or equal to 7 points, which were all good or excellent. The type of articles were mainly retrospective research (n=15), and the research contents were mainly lower limb amputation. The main reasons for amputation were peripheral vascular disease and diabetes mellitus (n=11). Wound infection, anemia, phantom limb pain, and psychological problems were common complications after amputation. Predictors of complications, secondary operations, and death included age, gender, smoking, drinking, obesity, preoperative comorbidities, level of amputation, anesthesia methods and other factors. Conclusions The focus of acute care after amputation should be wound healing, pain control, proximal physical movement and emotional support, especially for amputees who have prominent postoperative psychological problems. These patients need early psychological disease screening and mental support. After amputation, multi-disciplinary and multi-team coordinated care are needed to achieve both physical and psychological healing of the patient and promote early recovery.

Citation： LIN Meng, ZHANG Yaqing, YANG Fan, YAN Dirui, SU Fenghua, LI Sijian. Literature analysis of complications and predictive factors of amputees during postoperative hospitalization. West China Medical Journal, 2022, 37(4): 561-567. doi: 10.7507/1002-0179.202003423 Copy

1.	Bartels SA, VanRooyen MJ. Medical complications associated with earthquakes. Lancet, 2012, 379(9817): 748-757.
2.	Sinha R, van den Heuvel WJ, Arokiasamy P. Factors affecting quality of life in lower limb amputees. Prosthet Orthot Int, 2011, 35(1): 90-96.
3.	Low EE, Inkellis E, Morshed S. Complications and revision amputation following trauma-related lower limb loss. Injury, 2017, 48(2): 364-370.
4.	Rathore FA, Ayaz SB, Mansoor SN, et al. Demographics of lower limb amputations in the Pakistan military: a single center, three-year prospective survey. Cureus, 2016, 8(4): e566.
5.	Curran T, Zhang JQ, Lo RC, et al. Risk factors and indications for readmission after lower extremity amputation in the American College of Surgeons National Surgical Quality Improvement Program. J Vasc Surg, 2014, 60(5): 1315-1324.
6.	Law M, Stewart D, Pollock N, et al. Critical review form - quantitative studies. (2011-11-08)[2022-04-05]. https://unisa.kedu.au/siteassets/episerver-6-files/global/health/sansom/documents/icahe/cats/mcmasters_quantitative-review.pdf.
7.	Melcer T, Walker GJ, Galarneau M, et al. Midterm health and personnel outcomes of recent combat amputees. Mil Med, 2010, 175(3): 147-154.
8.	Ajibade A, Akinniyi OT, Okoye CS. Indications and complications of major limb amputations in Kano, Nigeria. Ghana Med J, 2013, 47(4): 185-188.
9.	Hasanadka R, McLafferty RB, Moore CJ, et al. Predictors of wound complications following major amputation for critical limb ischemia. J Vasc Surg, 2011, 54(5): 1374-1382.
10.	Tan TW, Eslami M, Rybin D, et al. Blood transfusion is associated with increased risk of perioperative complications and prolonged hospital duration of stay among patients undergoing amputation. Surgery, 2015, 158(6): 1609-1616.
11.	Fang ZB, Hu FY, Arya S, et al. Preoperative frailty is predictive of complications after major lower extremity amputation. J Vasc Surg, 2017, 65(3): 804-811.
12.	Park YH, Song JH, Choi GW, et al. Predictors of complication following lower extremity amputation in diabetic end-stage renal disease. Nephrology (Carlton), 2018, 23(6): 518-522.
13.	Belmont PJ Jr, Davey S, Orr JD, et al. Risk factors for 30-day postoperative complications and mortality after below-knee amputation: a study of 2, 911 patients from the national surgical quality improvement program. J Am Coll Surg, 2011, 213(3): 370-378.
14.	Ciufo DJ, Thirukumaran CP, Marchese R, et al. Risk factors for reoperation, readmission, and early complications after below knee amputation. Injury, 2019, 50(2): 462-466.
15.	Dunkel N, Belaieff W, Assal M, et al. Wound dehiscence and stump infection after lower limb amputation: risk factors and association with antibiotic use. J Orthop Sci, 2012, 17(5): 588-594.
16.	Gifford E, Anthony C, Kaji AH, et al. Unrecognized arteriosclerosis is associated with wound complications after below-knee amputation. Ann Vasc Surg, 2015, 29(2): 266-271.
17.	Phair J, DeCarlo C, Scher L, et al. Risk factors for unplanned readmission and stump complications after major lower extremity amputation. J Vasc Surg, 2018, 67(3): 848-856.
18.	Czerniecki JM, Thompson ML, Littman AJ, et al. Predicting reamputation risk in patients undergoing lower extremity amputation due to the complications of peripheral artery disease and/or diabetes. Br J Surg, 2019, 106(8): 1026-1034.
19.	Kantar RS, Alfonso AR, Rifkin WJ, et al. Risk factors for wound complications following transmetatarsal amputation in patients with diabetes. J Surg Res, 2019, 243: 509-514.
20.	朱天琦, 蒋宗滨, 赵劲民, 等. 截肢术后幻肢痛发生的多因素回归分析. 实用医学杂志, 2011, 27(24): 4398-4400.
21.	高雪莲, 冉坤, 向志. 截肢术后并发症的临床研究—附87例病例分析. 临床医药文献电子杂志, 2019, 6(11): 43-44.
22.	杨琳. 预见性护理对糖尿病足截肢术后患者并发症及康复效果的影响. 内蒙古中医药, 2018, 37(2): 117-119.
23.	Braaksma R, Dijkstra PU, Geertzen JHB. Syme amputation: a systematic review. Foot Ankle Int, 2018, 39(3): 284-291.
24.	Robbins CB, Vreeman DJ, Sothmann MS, et al. A review of the long-term health outcomes associated with war-related amputation. Phys Med Rehabil Clin N Am, 2009, 174(6): 588-592.
25.	卢中道, 王义生. 创伤性截肢术后并发症及处理. 医学与哲学, 2008, 29(12): 26-28.
26.	Sadat U, Chaudhuri A, Hayes PD, et al. Five day antibiotic prophylaxis for major lower limb amputation reduces wound infection rates and the length of in-hospital stay. Eur J Vasc Endovasc Surg, 2008, 35(1): 75-78.
27.	伍红平, 杨晓蓉. 地震伤员截肢术后早期并发症的预防及护理. 局解手术学杂志, 2010, 19(1): 67.
28.	Yoo S. Complications following an amputation. Phys Med Rehabil Clin N Am, 2014, 25(1): 169-178.
29.	Yin Y, Zhang L, Xiao H, et al. The pre-amputation pain and the postoperative deafferentation are the risk factors of phantom limb pain: a clinical survey in a sample of Chinese population. BMC Anesthesiol, 2017, 17(1): 69.
30.	Liu K, Tang T, Wang A, et al. Surgical revision for stump problems after traumatic above-ankle amputations of the lower extremity. BMC Musculoskelet Disord, 2015, 16: 48.
31.	Pratt LA, Brody DJ. Depression in the United States household population, 2005-2006. NCHS Data Brief, 2008(7): 1-8.
32.	Hamill R, Carson S, Dorahy M. Experiences of psychosocial adjustment within 18 months of amputation: an interpretative phenomenological analysis. Disabil Rehabil, 2010, 32(9): 729-740.
33.	Gallagher P, Maclachlan M. The Trinity Amputation and Prosthesis Experience Scales and quality of life in people with lower-limb amputation. Arch Phys Med Rehabil, 2004, 85(5): 730-736.
34.	王雪, 张国惠, 唐永利. 意外创伤截肢患者创伤后成长体验的质性研究. 护理学杂志, 2015, 30(6): 89-90, 99.
35.	Amoah V, Anokye R, Acheampong E, et al. The experiences of people with diabetes-related lower limb amputation at the Komfo Anokye Teaching Hospital (KATH) in Ghana. BMC Res Notes, 2018, 11(1): 66.
36.	Washington ED, Williams AE. An exploratory phenomenological study exploring the experiences of people with systemic disease who have undergone lower limb amputation and its impact on their well-being. Prosthet Orthot Int, 2016, 40(1): 44-50.
37.	Belon HP, Vigoda DF. Emotional adaptation to limb loss. Phys Med Rehabil Clin N Am, 2014, 25(1): 53-74.
38.	Mills E, Eyawo O, Lockhart I, et al. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med, 2011, 124(2): 144-154.e8.

1. Bartels SA, VanRooyen MJ. Medical complications associated with earthquakes. Lancet, 2012, 379(9817): 748-757.
2. Sinha R, van den Heuvel WJ, Arokiasamy P. Factors affecting quality of life in lower limb amputees. Prosthet Orthot Int, 2011, 35(1): 90-96.
3. Low EE, Inkellis E, Morshed S. Complications and revision amputation following trauma-related lower limb loss. Injury, 2017, 48(2): 364-370.
4. Rathore FA, Ayaz SB, Mansoor SN, et al. Demographics of lower limb amputations in the Pakistan military: a single center, three-year prospective survey. Cureus, 2016, 8(4): e566.
5. Curran T, Zhang JQ, Lo RC, et al. Risk factors and indications for readmission after lower extremity amputation in the American College of Surgeons National Surgical Quality Improvement Program. J Vasc Surg, 2014, 60(5): 1315-1324.
6. Law M, Stewart D, Pollock N, et al. Critical review form - quantitative studies. (2011-11-08)[2022-04-05]. https://unisa.kedu.au/siteassets/episerver-6-files/global/health/sansom/documents/icahe/cats/mcmasters_quantitative-review.pdf.
7. Melcer T, Walker GJ, Galarneau M, et al. Midterm health and personnel outcomes of recent combat amputees. Mil Med, 2010, 175(3): 147-154.
8. Ajibade A, Akinniyi OT, Okoye CS. Indications and complications of major limb amputations in Kano, Nigeria. Ghana Med J, 2013, 47(4): 185-188.
9. Hasanadka R, McLafferty RB, Moore CJ, et al. Predictors of wound complications following major amputation for critical limb ischemia. J Vasc Surg, 2011, 54(5): 1374-1382.
10. Tan TW, Eslami M, Rybin D, et al. Blood transfusion is associated with increased risk of perioperative complications and prolonged hospital duration of stay among patients undergoing amputation. Surgery, 2015, 158(6): 1609-1616.
11. Fang ZB, Hu FY, Arya S, et al. Preoperative frailty is predictive of complications after major lower extremity amputation. J Vasc Surg, 2017, 65(3): 804-811.
12. Park YH, Song JH, Choi GW, et al. Predictors of complication following lower extremity amputation in diabetic end-stage renal disease. Nephrology (Carlton), 2018, 23(6): 518-522.
13. Belmont PJ Jr, Davey S, Orr JD, et al. Risk factors for 30-day postoperative complications and mortality after below-knee amputation: a study of 2, 911 patients from the national surgical quality improvement program. J Am Coll Surg, 2011, 213(3): 370-378.
14. Ciufo DJ, Thirukumaran CP, Marchese R, et al. Risk factors for reoperation, readmission, and early complications after below knee amputation. Injury, 2019, 50(2): 462-466.
15. Dunkel N, Belaieff W, Assal M, et al. Wound dehiscence and stump infection after lower limb amputation: risk factors and association with antibiotic use. J Orthop Sci, 2012, 17(5): 588-594.
16. Gifford E, Anthony C, Kaji AH, et al. Unrecognized arteriosclerosis is associated with wound complications after below-knee amputation. Ann Vasc Surg, 2015, 29(2): 266-271.
17. Phair J, DeCarlo C, Scher L, et al. Risk factors for unplanned readmission and stump complications after major lower extremity amputation. J Vasc Surg, 2018, 67(3): 848-856.
18. Czerniecki JM, Thompson ML, Littman AJ, et al. Predicting reamputation risk in patients undergoing lower extremity amputation due to the complications of peripheral artery disease and/or diabetes. Br J Surg, 2019, 106(8): 1026-1034.
19. Kantar RS, Alfonso AR, Rifkin WJ, et al. Risk factors for wound complications following transmetatarsal amputation in patients with diabetes. J Surg Res, 2019, 243: 509-514.
20. 朱天琦, 蒋宗滨, 赵劲民, 等. 截肢术后幻肢痛发生的多因素回归分析. 实用医学杂志, 2011, 27(24): 4398-4400.
21. 高雪莲, 冉坤, 向志. 截肢术后并发症的临床研究—附87例病例分析. 临床医药文献电子杂志, 2019, 6(11): 43-44.
22. 杨琳. 预见性护理对糖尿病足截肢术后患者并发症及康复效果的影响. 内蒙古中医药, 2018, 37(2): 117-119.
23. Braaksma R, Dijkstra PU, Geertzen JHB. Syme amputation: a systematic review. Foot Ankle Int, 2018, 39(3): 284-291.
24. Robbins CB, Vreeman DJ, Sothmann MS, et al. A review of the long-term health outcomes associated with war-related amputation. Phys Med Rehabil Clin N Am, 2009, 174(6): 588-592.
25. 卢中道, 王义生. 创伤性截肢术后并发症及处理. 医学与哲学, 2008, 29(12): 26-28.
26. Sadat U, Chaudhuri A, Hayes PD, et al. Five day antibiotic prophylaxis for major lower limb amputation reduces wound infection rates and the length of in-hospital stay. Eur J Vasc Endovasc Surg, 2008, 35(1): 75-78.
27. 伍红平, 杨晓蓉. 地震伤员截肢术后早期并发症的预防及护理. 局解手术学杂志, 2010, 19(1): 67.
28. Yoo S. Complications following an amputation. Phys Med Rehabil Clin N Am, 2014, 25(1): 169-178.
29. Yin Y, Zhang L, Xiao H, et al. The pre-amputation pain and the postoperative deafferentation are the risk factors of phantom limb pain: a clinical survey in a sample of Chinese population. BMC Anesthesiol, 2017, 17(1): 69.
30. Liu K, Tang T, Wang A, et al. Surgical revision for stump problems after traumatic above-ankle amputations of the lower extremity. BMC Musculoskelet Disord, 2015, 16: 48.
31. Pratt LA, Brody DJ. Depression in the United States household population, 2005-2006. NCHS Data Brief, 2008(7): 1-8.
32. Hamill R, Carson S, Dorahy M. Experiences of psychosocial adjustment within 18 months of amputation: an interpretative phenomenological analysis. Disabil Rehabil, 2010, 32(9): 729-740.
33. Gallagher P, Maclachlan M. The Trinity Amputation and Prosthesis Experience Scales and quality of life in people with lower-limb amputation. Arch Phys Med Rehabil, 2004, 85(5): 730-736.
34. 王雪, 张国惠, 唐永利. 意外创伤截肢患者创伤后成长体验的质性研究. 护理学杂志, 2015, 30(6): 89-90, 99.
35. Amoah V, Anokye R, Acheampong E, et al. The experiences of people with diabetes-related lower limb amputation at the Komfo Anokye Teaching Hospital (KATH) in Ghana. BMC Res Notes, 2018, 11(1): 66.
36. Washington ED, Williams AE. An exploratory phenomenological study exploring the experiences of people with systemic disease who have undergone lower limb amputation and its impact on their well-being. Prosthet Orthot Int, 2016, 40(1): 44-50.
37. Belon HP, Vigoda DF. Emotional adaptation to limb loss. Phys Med Rehabil Clin N Am, 2014, 25(1): 53-74.
38. Mills E, Eyawo O, Lockhart I, et al. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med, 2011, 124(2): 144-154.e8.

West China Medical Journal

Literature analysis of complications and predictive factors of amputees during postoperative hospitalization

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