Indications and short term outcomes of major limb amputations at the university teaching hospitals adult and emergency hospital, Lusaka, Zambia.

Abstract

Introduction: Limb amputation is the surgical removal of all or part of a limb or extremity such as an arm, leg, foot, hand, toes or fingers. A major limb amputation is performed proximal to the wrist or ankle. There are various indications and short term outcomes for major limb amputations. Limb amputations can lead to poor outcomes such as morbidity, high cost on the patients and their families and an increase in the Disability Adjusted Life Years (DALY’s) and mortality. Therefore this study was aimed at assessing the indications and short term outcomes of major limb amputations at UTH-Adult hospital, Lusaka, Zambia. Methodology: This was a cross-sectional study with a 30 days follow-up after amputation was done. A data collection tool was administered after the amputation was done to collect demographics, indications that led to the amputation, information on the operation as well as any complications that occurred. The patient was followed up on day 1, 7, 14 and 30 while in the hospital and the outpatient clinic. The data collected was analysed using STATA version 13. Results: A total of 80 patients recruited into the study and 43(53.8%) were males and 37(46.3%) were females. The mean age of the patients was 52.2(SD, 17). The most common indication was found to be diabetic foot 36 (45%). Only 9(11.3%) were amputated due to trauma. Out of the 80 patients, 54(67.5%) developed a complication, 48 (88.9%) had local complications and 11(20.4%) had systemic complications. The most common complication was surgical site infection alone 24 (44.4%), followed by those that had multiple 13 (24.1%) then phantom limb pain (16.7%). Renal complications accounted for 6(11.1%) of those that developed a complication. The 30-day mortality rate was 18.8% with sepsis being the most common cause of death, followed by septic shock and acute kidney injury. Conclusion: The main indication for major limb amputations at UTH was diabetic foot and trauma was amongst the least. The most common postoperative complication was surgical site infection. The 30-day mortality rate was 18.8% with sepsis being the main cause of death. Recommendation: Formation of diabetic foot clinics in the primary health centres to diagnose and treat complications of diabetes that may lead to limb amputation. Keywords: Indications, short term outcomes, limb, amputations, University Teaching Hospital, Zambia