TH4.6 Is major limb amputation the most appropriate means of palliation for patients with non-reconstructable arterial disease?

Abstract

Abstract Introduction Major limb amputation (MLA) is the highest risk lower limb surgical procedure performed in the United Kingdom with reported in hospital mortality 9.1%. For patients with non-reconstructable arterial disease it offers palliation of symptoms. The primary aim of the current work was to define if surgical palliation with major limb amputation is being offered to patients who may have been best managed medically Methods Retrospective review of major limb amputations (March 2019 to October 2021). Historical datasets have also been scrutinised (2008–2010). Specific variables of interest included the annual number of major limb amputations, mortality on the index admission and place of discharge. Results A complete dataset was available for 282 patients during the Covid period. Patient demographics were as anticipated - 206 (73%) male, mean age 63-years (range 23 to 90-years). Peripheral arterial disease (190) and diabetes mellitus (149) were common. The number of major limb amputations was comparable with the historical series. In-hospital mortality was 7% (n=20). The median duration of admission for patients who survived was 26-days and 38% of patients were limb-fitted (which was also comparable with historical data). Most patients (71%) were discharged to their own home. Conclusion The outcomes described are better than the comparable local historical and national data both in terms of in-hospital mortality and place of discharge. These data imply that we make the correct decision about MLA more often than we don't.