Major Limb Amputation Research Articles

Chronic Kidney Disease Predicts Greater 5-Year Mortality Following Major Limb Amputation.

Severe chronic kidney disease (CKD) predicts greater mortality after major lower extremity amputation (MLEA), but it remains poorly understood whether this finding extends to patients with earlier stages of CKD. We assessed outcomes for patients with CKD in a retrospective chart review of all patients who underwent MLEA at a large tertiary referral center from 2015 to 2021. We stratified 398 patients by glomerular filtration rate (GFR) and conducted Chi-Square and survival analysis. Preoperative CKD diagnosis was associated with many comorbidities, less 1-year follow-up, and greater 1- and 5-year mortality. Kaplan-Meier analysis showed worse 5-year survival for patients with any stage of CKD (62%) compared to patients without CKD (81%; P < .001). Greater 5-year mortality was independently predicted by moderate CKD (hazard ratio (HR) 2.37, P = .02) as well as severe CKD (HR 2.09, P = .005). These findings demonstrate the importance of identifying and treating CKD early preoperatively.

5-Year Outcomes of Drug-Coated Balloons for Peripheral Artery In-Stent Restenosis, Long Lesions, and CTOs

BackgroundLong-term data on drug-coated balloon (DCB) outcomes in complex femoropopliteal atherosclerotic lesions are limited. ObjectivesThe authors sought to report 5-year safety and effectiveness outcomes of a paclitaxel DCB for the treatment of de novo in-stent restenosis (ISR), long lesions (LL), or chronic total occlusions (CTOs) in the prespecified imaging cohorts of the IN.PACT Global Study. MethodsThe IN.PACT Global study was a prospective, international single-arm study. Assessments through 5 years included freedom from clinically driven target lesion revascularization (CD-TLR), a safety composite (freedom from device- and procedure-related death to 30 days, and freedom from major target limb amputation and freedom from clinically driven target vessel revascularization within 60 months), and major adverse events. ResultsThe prespecified imaging cohorts enrolled 132 de novo ISR, 158 LL, and 127 CTO participants. Kaplan-Meier estimates of freedom from CD-TLR through 5 years were 58.0% (ISR), 67.3% (LL), and 69.8% (CTO). The cumulative incidences of the composite safety endpoint were 56.0% (ISR), 65.7% (LL), and 69.8% (CTO). The 5-year freedom from all-cause mortality with vital status update were 81.4% (ISR), 75.2% (LL), and 78.2% (CTO). Within the ISR cohort, 15.9% of participants experienced 2 or more TLRs, compared with 9.5% and 5.5% in the LL and CTO groups, respectively. ConclusionsResults demonstrate long-term safety and effectiveness of this DCB in all 3 cohorts, with low reintervention rates in the LL and CTO cohorts and no safety issues. These results support the inclusion of this DCB into the treatment algorithm for complex femoropopliteal disease.

Abstract 134: A Single-cell Atlas Of Human Skeletal Muscle Tissue In Chronic Limb-threatening Ischemia

Introduction: Chronic limb-threatening ischemia (CLTI) represents end-stage peripheral arterial disease (PAD) and is a significant cause of limb amputation and mortality. Evidence supports the importance of skeletal muscle responses in the pathobiology of CLTI. Skeletal muscle regeneration depends on the coordinated activity of muscle stem cells (MuSCs) and an array of non-myogenic cells, including immune cells and fibroadipogenic progenitors (FAPs). The mechanisms underlying failed muscle regeneration in the CLTI limb are unknown. Single-cell RNA sequencing (scRNA-seq) facilitates the deconvolution of multicellular tissues in homeostatic and pathologic conditions. Herein, we profiled the transcriptomes of 135,203 cells from lower extremity skeletal muscle of PAD patients to construct a cellular atlas of CLTI. Methods: We recruited 12 PAD patients undergoing major limb amputation for CLTI. We obtained proximal (non-ischemic) and distal (ischemic) muscle samples from each patient and used scRNA-seq to profile the transcriptomes of 1,700 – 20,000 cells per sample. Results: We observed 10 distinct cellular populations in the CLTI limb. The predominant cell types were MuSCs, FAPs, and immune cells. There was significant transcriptional heterogeneity in each population; we defined a range of MuSC, FAP, and macrophage sub-populations and identified specific FAPs and macrophages associated with tissue ischemia. Using CellChat analysis, we found differential cell-cell signaling probabilities in ischemic vs. non-ischemic muscle. In ischemic muscle, FAPs are the primary source of outgoing signals, while macrophages are the primary receiver. Conclusions: Our single-cell atlas highlights the transcriptional heterogeneity of cellular responses in the CLTI limb. This atlas will serve as a resource for future studies of the molecular underpinnings of CLTI, advance our understanding of its pathogenesis, and support the development of novel therapies.

Management of Critical Limb Ischemia Prognostic Factors

Introduction: Critical limb ischemia (CLI) represents the most severe form of Peripheral artery disease (PAD). Its prevalence is estimated to be between 0.5% and 2.3% of the population over 40 years old. Despite its importance, epidemiological studies on CLI remain patchy. In Morocco, few studies have been carried out on this subject, and we have no epidemiological data on the morbimortality of chronic critical ischemia of the lower limbs on a national scale. Objective: The objective of our study was to evaluate the results of surgical treatment of critical limb ischemia and to identify the factors associated with the medium-term evolution. Methods: We conducted a retrospective cohort study of all patients admitted to the vascular surgery department of the Hassan II University Hospital for the management of critical ischemia of the lower limbs, who underwent revascularization surgery between 01/01/2013 and 31/12/2019. Patients who underwent a major amputation of the affected limb and those for whom the revascularization procedure was a revision were subsequently excluded. The follow-up period was 2 years and the events of major interest were the occurrence of a major limb amputation and 30-day mortality. Results: The cohort included 232 patients with critical ischemia. The mean age was 62 years with a clear male predominance of 84.5%. The most common comorbidities were diabetes (65.8%), active smoking (42.5%), and hypertension (31.2%). The majority of patients (62%) benefited from endovascular procedures. The primary technical success was 94.1%, the major amputation rate was 19.7%, and the 30-day mortality was 4.3%. In multivariate analysis, factors independently associated with a high postoperative complication rate were preoperative hyperglycemia, concomitant ischemic heart disease, female sex, young age, and intensive care unit stay. Conclusion: Our study highlights several risk factors for the occurrence of postoperative complications of CLI. These results .....

Amputation of the Unsalvageable Leg in Vascular Patients with Cancer.

The aim of this study was to compare outcomes of major lower limb amputation (MLA) in patients with and without cancer and with cancer patients receiving palliation over amputation for their unsalvageable limb. Cancer patients who underwent a major amputation or palliation between 2013 and 2018 were included. Comparison groups were cancer-MLA (active/managed cancers), non-cancer MLA (historic cancer or no cancer history) and cancer-palliation at presentation with unsalvageable limbs. Prospectively collected data was retrospectively analysed for outcomes including survival, postoperative complications, length of stay, suitability for rehabilitation and discharge destination. 262 (cancer and non-cancer) patients underwent MLA and 18 patients with cancer received palliation. Of those amputated, 26 (9.9%) had active or managed cancer, of which 12 were diagnosed in the 6months before MLA. Cancer-MLA patients presented with more acute ischaemia compared to non-cancer patients. Median survival was significantly different between the cancer-MLA (14.1 [9.5 - 29.5, 95% CI] months), non-cancer MLA (57.7 [45 - 73.6, 95% CI] months) and cancer-palliation (.6 [.4 - 2.3, 95% CI] months) groups, P < .001. A significantly higher proportion of cancer-MLA patients (10/26, 38.5%) were deemed unsuitable for rehabilitation in post-operative assessment compared to non-cancer MLA (21/236, 8.9%) patients, P < .001. There was a variation in destinations of discharge, with a greater proportion of cancer-MLA patients (4/26, 15.4%) going to a nursing home compared to non-cancer MLA (10/236, 4.2%) patients, P = .016. Cancer is prevalent among vascular amputees, with a large proportion being occult diagnoses. Cancer is associated with poorer outcomes following amputation, but survival remains significantly better compared to palliation in cancer patients presenting with unsalvageable limbs.

Mirror Therapy for the Management of Phantom Limb Pain: A Single- Center Experience

Phantom limb pain (PLP) can have devastating consequences, affecting up to 90% of amputees. PLP is associated with analgesia dependence and impaired quality of life. Mirror therapy (MT) is a novel treatment that has been applied in other pain syndromes. We prospectively evaluated MT in the management of PLP. Prospective study of patients recruited between 2008 - 2020 who underwent unilateral major limb amputation, with a healthy contralateral limb. Participants were invited to attend weekly MT sessions. Pain in the seven days prior to each MT session was scored on a visual analogue scale (VAS -0-10mm) and the short form McGill pain questionnaire (SFMPQ). 98 patients (68M: 30F) ages 17-89 years were recruited over 12 years. 44% of patients had amputations due to peripheral vascular disease. Over an average of 2.5 sessions, the final treatment score on the VAS scale was 2.6 (SD ±3.0) with a reduction of 4.5 points on VAS score. As a comparison using the SFMQ scoring system, the average final treatment score was 3.2 (±5.0) with 91% overall improvement. Mirror therapy is a very powerful and effective intervention for PLP. It is an exciting addition to the armoury of vascular surgeons in the management of this condition.

Assessment of risk factors determining the prognosis of major and minor limb amputations in patients with diabetic foot ulcers

Assessment of risk factors determining the prognosis of major and minor limb amputations in patients with diabetic foot ulcers

The Impact of the COVID-19 Pandemic on a Dedicated Vascular Emergency Clinic

Vascular Emergency Clinics (VEC) improve patient outcomes in chronic limb-threatening ischaemia (CLTI). They provide a "one stop" open access policy, whereby "suspicion of CLTI" by a healthcare professional or patient leads to a direct review. We assessed the resilience of the outpatient VEC model to the first year of the coronavirus disease (COVID-19) pandemic. A retrospective review of a prospectively maintained database of all patients assessed in our VEC for lower limb pathologies between March 2020 and April 2021 was performed. This was cross referenced to national and loco-regional Governmental COVID-19 data. Individuals with CLTI were further analysed to determine PAD-QIF (Peripheral Arterial Disease - Quality Improvement Framework) compliance. Seven hundred and ninety-one patients attended for 1084 assessments (Male n = 484, 61%; Age 72.5 ± SD 12.2 years; White British n = 645, 81.7%). In total, 322 patients were diagnosed with CLTI (40.7%). A total of 188 individuals (58.6%) underwent a first revascularisation strategy (Endovascular n=128, 39.8%; Hybrid n=41, 12.7%; Open surgery n=19; 5.9%; Conservative n=134; 41.6%). Major lower limb amputation rate was 10.9% (n=35) and mortality rate was 25.8% (n=83) at 12 months follow up. Median referral to assessment time was 3 days (IQR 1-5). For the non-admitted patient with CLTI, the median assessment to intervention was eight days (IQR 6-15) and median referral to intervention time of 11 days (11-18). The VEC model has demonstrated strong resilience to the COVID-19 pandemic with rapid treatment timelines maintained for patients with CLTI.

INTRAMUSCULAR INTERPOSITION OF NERVE ENDINGS TO MINIMIZE NEUROPATHIC AND RESIDUAL PAIN IN LOWER LIMB AMPUTEES

A major cause of morbidity in lower limb amputees is phantom limb pain (PLP) and residual limb pain (RLP). This study aimed to determine if surgical interposition of nerve endings into adjacent muscle bellies at the time of major lower limb amputation can decrease the incidence and severity of PLP and RLP.Data was retrospectively collected from January 2015 to January 2021, including eight patients that underwent nerve interposition (NI) and 36 that received standard treatment. Primary outcomes included the 11-point Numerical Rating Scale (NRS) for pain severity, and Patient-Reported Outcomes Measurement Information System (PROMIS) pain intensity, behaviour, and interference. Secondary outcome included Neuro-QoL Lower Extremity Function assessing mobility. Cumulative scores were transformed to standardised t scores.Across all primary and secondary outcomes, NI patients had lower PLP and RLP. Mean ‘worst pain’ score was 3.5 out of 10 for PLP in the NI cohort, compared to 4.89 in the control cohort (p=0.298), and 2.6 out of 10 for RLP in the NI cohort, compared to 4.44 in the control cohort (p=0.035). Mean ‘best pain’ and ‘current pain’ scores were also superior in the NI cohort for PLP (p=0.003, p=0.022), and RLP (p=0.018, p=0.134).Mean PROMIS t scores were lower for the NI cohort for RLP (40.1 vs 49.4 for pain intensity; p=0.014, 44.4 vs 48.2 for pain interference; p=0.085, 42.5 vs 49.9 for pain behaviour; p=0.025). Mean PROMIS t scores were also lower for the NI cohort for PLP (42.5 vs 52.7 for pain intensity; p=0.018); 45.0 vs 51.5 for pain interference; p=0.015, 46.3 vs 51.1 for pain behaviour; p=0.569). Mean Neuro-QoL t score was lower in NI cohort (45.4 vs 41.9;p=0.03).Surgical interposition of nerve endings during lower limb amputation is a simple yet effective way of minimising PLP and RLP, improving patients’ subsequent quality of life. Additional comparisons with targeted muscle reinnervation should be performed to determine the optimal treatment option.

Medical Management of Peripheral Artery Disease.

Peripheral artery disease (PAD) is a common type of atherosclerotic disease of the lower extremities associated with reduced quality of life and ambulatory capacity. Major adverse cardiovascular events and limb amputations are the leading cause of morbidity and mortality in this population. Optimal medical therapy is therefore critical in these patients to prevent adverse events. Risk factor modifications, including blood pressure control and smoking cessation, in addition to antithrombotic agents, peripheral vasodilators, and supervised exercise therapy are key pillars of medical therapy. Revascularization procedures represent key touch points between patients and health care providers and serve as opportunities to optimize medical therapy and improve long-term patency rates and outcomes. This review summarizes the aspects of medical therapy that all providers should be familiar with when caring for patients with PAD in the peri-revascularization period.

Aortoiliac: Covered, Uncovered, CERAB as It Relates to Peripheral Arterial Disease.

Peripheral arterial disease (PAD) affects over 200 million worldwide and is the leading cause of major limb amputation, with individuals suffering from PAD being at three times greater risk of dying compared with matched controls. TASC-II guidelines provide a consensus on the management of PAD based on the collaboration between international vascular specialties. These guidelines previously outlined open surgery as the gold standard for treatment of aortoiliac disease and PAD as it has demonstrated consistent long-term results. However, this approach is also associated with high perioperative mortality, especially when compared with endovascular techniques. With recent developments in endovascular technology, user technique, and experience, this approach has become more widely used as primary intervention for aortoiliac disease. One of these novel techniques includes covered endovascular reconstruction of the aortic bifurcation, which has demonstrated excellent technical success and improved primary and secondary patency rates with follow-up. The aim of this review is to compare the efficacy of these approaches to the treatment of aortoiliac disease and demonstrate the benefits of the shift toward an endovascular-first approach to treatment of this disease, regardless of lesion complexity or severity.

Targeted Muscle Reinnervation for Limb Amputation to Avoid Neuroma and Phantom Limb Pain in Patients Treated at a Pediatric Hospital.

Patients undergoing major limb amputation with TMR were included with minimum one year follow-up and completed questionnaires. Primary clinical outcomes included incidence of symptomatic neuromas, PLP, residual limb pain, narcotic use, and neuromodulator use. A follow-up phone survey was conducted assessing five pediatric Patient Reported Outcomes Measurement Information System (PROMIS) metrics adapted to assess residual limb and PLP. Nine patients (seven male and two female patients, avg. age = 16.83 ± 7.16 years) were eligible. Average time between surgery and phone follow-up was 21.3 ± 9.8 months. Average PROMIS Pediatric t-scores for measures of pain behavior, interference, quality-affective, and quality-sensory for both PLP and residual limb pain were nearly 1 standard deviation lower than the United States general pediatric population. One patient developed a symptomatic neuroma 1 year after surgery. Compared with an adult patient sample reported by Valerio et al, our TMR patients at Nationwide Children's Hospital (NCH) showed similar PLP PROMIS t-scores in pain behavior (50.1 versus 43.9) and pain interference (40.7 versus 45.6). Both pediatric and adult populations had similar residual limb pain including PROMIS pain behavior (36.7 adult versus 38.6 pediatric) and pain interference (40.7 adult versus 42.7 pediatric). TMR at the time of amputation is feasible, safe, and should be considered in the pediatric population.

Predicting Functional Outcome After Major Lower Limb Amputation

Predicting Functional Outcome After Major Lower Limb Amputation

Amputation and advance care plans: An observational study exploring decision making and long-term outcomes in a vascular centre.

Half of those undergoing major lower limb amputation for peripheral arterial disease die within 1year. Advance care planning reduces days in hospital and increases the chance of dying in a preferred place. To investigate the prevalence and content of advance care planning for people having a lower limb amputation due to acute or chronic limb-threatening ischaemia or diabetes. Secondary aims were to explore its association with mortality, and length of hospital stay. A retrospective observational cohort study. The intervention was advance care planning. Patients admitted to the South West England Major Arterial Centre between 1 January 2019 and 1 January 2021 who received unilateral or bilateral below, above, or through knee amputation due to acute or chronic limb-threatening ischaemia or diabetes. 116 patients were included in the study. 20.7% (n = 24) died within 1year. 40.5% (n = 47) had an advance care planning discussion of which all included cardiopulmonary resuscitation decisions with few exploring other options. Patients who were more likely to have advance care planning discussions were ≥75years (aOR = 5.58, 95%CI 1.56-20.0), female (aOR = 3.24, 95%CI 1.21-8.69), and had multimorbidity (Charlson Comorbidity Index ≥5, aOR = 2.97, 95%CI 1.11-7.92). Discussions occurred more often in the emergency pathway and were predominantly initiated by physicians. Advance care planning was associated with increased mortality (aHR = 2.63, 95%CI 1.01, 5.02) and longer hospital stay (aHR = 0.52, 95%CI 0.32-0.83). Despite a high risk of death for all patients in the months following amputation, advance care planning occurred in fewer than half of people and mostly focused on resuscitation.

Incidence of Deep Venous Thrombosis (DVT) Postoperatively Following Major Lower Limb Amputation in Patients on Prophylactic Anticoagulation

Incidence of Deep Venous Thrombosis (DVT) Postoperatively Following Major Lower Limb Amputation in Patients on Prophylactic Anticoagulation

Health Related Quality of Life in patients undergoing Lower Limb Amputation secondary to Peripheral Arterial Disease

Aim: To assess domains of health-related quality of life among patients undergoing major lower limb amputation secondary to peripheral arterial disease. Study design: Observational questionnaire-based study. Place and Duration: Data from 1st January to 31 December 2020(collected from September 2022 to November 2022) was assessed out of which ninety-one patients fulfilled the inclusion criteria. Methodology: Twenty-three patients were interviewed after verbal consent over telephone using validated questionnaires: World Health Organization Quality of Life-BREF, Amputee Single Item Mobility Measure, Locomotor Capability Index-5. Independent sample t-tests and ANOVA were performed for demographics and domain scores. Pearson-Correlation tests were performed for relations between domains and mobility scores. Results: 12 (52.20%) of interviewed patients received below knee amputation, comprising mostly of males 16 (69.60%) with diabetes 18 (78.30%). Participants who used prosthesis had statistically significantly greater mobility scores compared to non-prosthesis users t(21)=3.396, p=0.03. Below knee amputees report better quality of life compared to above knee as these amputees had lower physical domain (mean difference -22.75, p=0.027) and environmental domain scores (mean difference -12.44, p=0.009). This study found that male participants had statistically significantly greater physical t(21)=2.698, p=0.013 and environmental t(21)=2.77,1 p =0.011 scores after a major lower limb amputation compared to females. Conclusion: Males and patients with prosthesis report significantly better quality of life compared to females and non-prosthesis users, owing to socioeconomic and cultural barriers. Keywords (MeSH): Amputation, Surgical, peripheral arterial disease, Artificial Limbs, Quality of Life

LIMB LOSS: FACTS&amp; STATISTICS - A CROSS SECTIONAL STUDY AMONG AMPUTEES REPORTING TO A TERTIARY CARE CENTRE IN TAMILNADU

Background: Despite advances in medical interventions and emphasis on prevention programs, studies have shown that the rate of amputation procedures and prevalence of persons living with limb loss continues to increase. Today, when amputation is necessary, surgery is undertaken with consideration for the functional aspects of the residual limb.The purpose of this study was to describe the etiology and characteristics of major limb amputees at GIRM, a tertiary care centre. Materials and Methods: It is a cross sectional study, including a total of 500 patients, underwent limb amputations for various reasons, who has reported for prosthesis fitting and disability certificate at Government Institute of Rehabilitation Medicine, Chennai for a period of 1 year from January 2022 to December 2022.In this study, we studied several variablesincluding age, sex,side of the limb, level of the amputation, etiology etc. Results: In this study, dysvascular disease was the major reason of amputation, followed by traumatic cause, with a male preponderance, with peaking at the age of 41-60 years. Lower limb, being the most common with predominance of transtibial amputation. Conclusion: In contrast to declining rates of trauma-related and cancer-related amputations, we found evidence of a significant increase in the incidence of amputations due to diabetic foot syndrome.Overall, the risk of amputations increased with age. This was true for all etiologies and for both sexes. Males with an average age of 50 generally at higher risk for limb loss than women.

Predictors for Distal Revascularization Following Femoral Endarterectomy in Chronic Limb-Threatening Ischemia Patients.

This study aims to identify the clinical variables which are predictive for the benefit of concomitant distal revascularization (DR) to prevent Chronic limb-threatening ischemia (CLTI) progression and the need for major limb amputation. This is a retrospective cohort study of patients who presented with lower limb ischemia and required at least femoral endarterectomy (FEA), recruited over a period of 15years (2002-2016). The patient cohort was divided into three groups based on the type of intervention: A (FEA alone), B (FEA + catheter-based intervention/(CBI)), and C (FEA + surgical bypass (SB)). The primary endpoint was to identify independent predictors for the use of concomitant DR (CBI or SB). Secondary endpoints were amputation rate, length of stay, mortality rate, postoperative ankle-brachial index and complications, readmission rate, re-intervention rate, resolution of symptoms and wound status. A total of 400 patients were included, 68.0% were males. Most presenting limbs were at Rutherford class (RC) III and WIfI stage 2, with an ankle-brachial index (ABI) of .47 ± .21 and a TASC II class C lesion. No significant differences were found in the primary-assisted and secondary patency rates between the three groups (P > .05, in all). In the multivariate analyses, clinical variables associated with DR were hyperlipidemia (hazard ratio (HR) 2.1-2.2), TASC II D (HR 2.62), Rutherford class 4 (HR 2.3) and 5 (HR 3.7), as well as WIfI stage ≥3 (HR 1.48). Femoral endarterectomy is sufficient to treat intermittent claudication. However, patients in whom rest pain, tissue loss or TASC II D anatomic lesion severity are present may benefit from concomitant distal revascularization. Taking into consideration the overall assessment of operative risk factors for each individual patient, proceduralists should have a lower threshold for performing early or concomitant distal revascularization to reduce CLTI progression including additional tissue loss and/or major limb amputation.

Overcoming Barriers to Wound Healing in a Neuropathic and Neuro-Ischaemic Diabetic Foot Cohort Using a Novel Bilayer Biodegradable Synthetic Matrix.

Diabetes-related foot ulceration presents an increasing risk of lower limb amputation globally, driving the search for new treatment technologies. Our single-centre prospective observational study reports on the impact of bilayer biodegradable synthetic matrix technology (NovoSorb® BTM) on the healing and amputation rates of a diabetic foot ulceration cohort. Consecutive patients with a diabetes-related foot ulceration treated with NovoSorb BTM, between December 2019 and October 2021, were followed for 12 months. Complete wound healing and amputation outcomes were observed. Amputation risk was stratified using the Wound, Ischaemia and foot Infection (WIfI) classification system. Study outcomes were compared with recently published meta-analysis data to evaluate the impact of the synthetic matrix. In total, 25 NovoSorb BTM applications to 23 wounds in 22 patients were observed. Complete wound healing was observed in 15 of the wounds, 3 retained chronic wounds, 3 required minor amputation and 2 required major limb amputation. Further, 12-month WIfI amputation risk analysis saw 18 patients stratified to WIfI stage 4, 4 to WIfI stage 3 and 1 to WIfI stage 1. Our observed 12-month major amputation rates were 11.1% (n = 2) for stage 4 and 0% for stages 3 and 1. Our early experience suggests that NovoSorb BTM is a safe and effective treatment for moderate to severe diabetes-related foot ulceration. While larger-scale data are required, NovoSorb BTM may represent a promising new addition to the armamentarium of clinicians, who strive to achieve limb salvage in this complex cohort of patients.

From hospital to home following a lower limb amputation: A focus group study of healthcare professionals’ views and experiences with transitioning

IntroductionPatients undergoing major lower limb amputation often have multiple comorbidities, requiring care from numerous healthcare professionals (HCPs). Furthermore, they may experience physical, medical and practical challenges post-amputation. Patients with complex needs are particularly vulnerable during care transitions and may benefit from integrated care models. AimThis study aimed to explore HCPs’ views and experiences regarding the transition process after implementing an integrated care model for patients with lower limb amputation. MethodsWe conducted two focus groups with 13 HCPs from a Danish hospital and three surrounding districts; all working in the Safe Journey programme. The interviews were analysed using thematic analysis. ResultsThree themes were created: 1) becoming a team across sectors, 2) continuity of care as a driver for patient safety and 3) challenges in achieving safe transitions. The Safe Journey programme facilitated the construction of an interdisciplinary team, cross-sectoral communication and professional relations, increasing HCPs’ sense of improved patient safety and care continuity. However, HCPs experienced an increased workload, including coordination and at-home patient visits. ConclusionsHCPs found the Safe Journey programme to be valuable for patients undergoing major lower limb amputation and promotive of cross-sectoral professional relations, communication, continuity and patient safety. However, the programme was time- and resource-consuming compared to conventional models.