The effect of amputation level on patient mental and psychological health, prospective observational cohort study.

Abstract

Non-traumatic lower limb amputation is a commonly performed surgical procedure and is associated with a high prevalence of psychological morbidity including anxiety and depression. Many risk factors have been identified, including the indication for amputation, perioperative pain and sociodemographic factors. The aim of this study was to identify whether level of amputation has an impact on this psychological morbidity. A prospective observational study was conducted in a tertiary vascular unit including all adult non-traumatic amputations performed during a 6 month period. The Hospital Anxiety and Depression Scale (HADS) was used to score anxiety and depression pre and postoperatively. 49 patients met the inclusion criteria (22 trans-femoral amputations (AKA) and 27 trans-tibial amputations (BKA)). HADS scores for anxiety and depression were high in both groups both pre and postoperatively. A higher level of anxiety was noted in the BKA group, significantly decreasing postoperatively (p<0.05). No other statistically significant differences were found between the two groups. In non-traumatic amputations, there appears to be a higher rate of pre-operative anxiety in patients undergoing trans-tibial amputation compared with trans-femoral amputees. However, the level of amputation does not appear to have a significant effect on psychological status of patients with high rates of depression and anxiety demonstrated in both groups.