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- Author or Editor: Amanda Crowell x
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Background:
One relatively universal functional goal after major lower-limb amputation is ambulation in a prosthesis. This retrospective, observational investigation sought to 1) determine what percentage of patients successfully walked in a prosthesis within 1 year after major limb amputation and 2) assess which patient factors might be associated with ambulation at an urban US tertiary-care hospital.
Methods:
A retrospective medical record review was performed to identify consecutive patients undergoing major lower-limb amputation.
Results:
The overall rate of ambulation in a prosthesis was 29.94% (50.0% of those with unilateral below-the-knee amputation [BKA] and 20.0% of those with unilateral above-the-knee amputation [AKA]). In 24.81% of patients with unilateral BKA or AKA, a secondary surgical procedure of the amputation site was required. In those with unilateral BKA or AKA, statistically significant factors associated with ambulation included male sex (odds ratio [OR] = 2.50) and at least 6 months of outpatient follow-up (OR = 8.10), survival for at least 1 postoperative year (OR = 8.98), ambulatory preamputation (OR = 14.40), returned home after the amputation (OR = 6.12), and healing of the amputation primarily without a secondary surgical procedure (OR = 3.62). Those who had a history of dementia (OR = 0.00), a history of peripheral arterial disease (OR = 0.35), and a preamputation history of ipsilateral limb revascularization (OR = 0.14) were less likely to walk. We also observed that patients with a history of outpatient evaluation by a podiatric physician before major amputation were 2.63 times as likely to undergo BKA as opposed to AKA and were 2.90 times as likely to walk after these procedures.
Conclusions:
These results add to the body of knowledge regarding outcomes after major amputation and could be useful in the education and consent of patients faced with major amputation.
Background:
A patient “handoff,” or the “sign-out” process, is an episode during which the responsibility of a patient transitions from one health-care provider to another. These are important events that affect patient safety, particularly because a significant proportion of adverse events have been associated with a relative lack of physician communication. The objective of this investigation was to survey podiatric surgical residency programs with respect to patient care handoff and sign-out practices.
Methods:
A survey was initially developed and subsequently administered to the chief residents of 40 Council on Podiatric Medical Education–approved podiatric surgical residency programs attempting to elucidate patient care handoff protocols and procedures and on-call practices.
Results:
Although it was most common for patient care handoffs to occur in person (60.0%), programs also reported that handoffs regularly occurred by telephone (52.5%) and with no direct personal communication whatsoever other than the electronic passing of information (50.0%). In fact, 27.5% of programs reported that their most common means of patient care handoff was without direct resident communication and was instead purely electronic. We observed that few residents reported receiving formal education or assessment/feedback (17.5%) regarding their handoff proficiency, and only 5.0% of programs reported that attending physicians regularly took part in the handoff/sign-out process. Although most programs felt that their sign-out practices were safe and effective, 67.5% also believed that their process could be improved.
Conclusions:
These results provide unique information on a potentially underappreciated aspect of podiatric medical education and might point to some common deficiencies regarding the development of interprofessional communication within our profession during residency training.
