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Majority of patients who undergo amputations receive 'poor' care

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Fewer than half of leg amputation patients in England and Wales receive good care, according to a new report.

The study found that poor co-ordination between health professionals was one of the main reasons why just 44% of 519 patients questioned felt their treatment was good.

Nearly a quarter of patients who underwent an emergency amputation should have had elective surgery planned in advance, it said.

Meanwhile, almost nine out of 10 amputees did not have a named individual responsible for co-ordinating discharge planning and rehabilitation.

The National Confidential Enquiry into Patient Outcome and Death (NCEPOD), which carried out the investigation, also highlighted concerns about the growth in diabetes that is increasingly leading to amputation.

Just over one in 10 patients with diabetes were admitted under the care of the diabetes service.

“A significant improvement is needed in the care of amputation patients”

Michael Gough

Hundreds of patients aged 16 and over who had amputations below the hip were included in the study.

Professor Michael Gough, lead report author and consultant vascular surgeon, said: “A significant improvement is needed in the care of amputation patients given that fewer than half received good care, and that the mortality rate of 12.4% for the procedure was higher than has been reported in the US (9.6%).

“Having a limb removed is a life-changing experience and patients need to be supported by a wide range of health professionals other than just the surgeon,” he said.

Surgery

Michael Gough

“Good multidisciplinary care from the outset is required to ensure that these patients, who often have multiple medical problems, receive the best possible treatment, including treatment of diabetes and heart problems, physiotherapy, rehabilitation and a properly planned discharge,” said Professor Gough.

He added: “Many amputations are performed in the emergency operating theatre and are often subject to last-minute cancellation. These are high-risk patients and they should be given the benefit of surgery in normal working hours where senior doctors can oversee their care.”

Recent figures show that more than 5,000 people in England, Wales and Northern Ireland undergo a major amputation each year.

The report, Lower Limb Amputation: Working Together, makes a number of recommendations. These include discharge planning to start as soon as the need for amputation is identified and reviews of patients with diabetes by specialist teams.

“Our advisers found room for improvement in every aspect of both the organisation”

Bertie Leigh

NCEPOD chair Bertie Leigh said: “In a nutshell, it seems we are not doing well enough. Our advisers found room for improvement in every aspect of both the organisation and the clinical delivery of care to patients having amputations.

“This group of patients must be recognised and described in one set of protocols or clinical care pathways that will be applied by the whole team of practitioners,” he said.

“Getting it wrong can have tragic consequences for individuals, and our report also shows how hard it is to get care right. NCEPOD is dedicated to fighting to make it better at a time when NHS resources are under fire as never before,” he said.

“This report is a cogent reminder of what we have to lose if we don’t get it right,” he added.

  • 1 Comment

Readers' comments (1)

  • Many patients arrive at the point of amputation as the result of persistent non-compliance.

    Most will have received advice about the importance of weight reduction, good blood sugar control, diet, etc,etc.

    Patients do, and should be made aware of , their own personal responsibilities.

    Perhaps we should be requiring signed acknowledgement from patients to the effect they have received good advice.

    Unsuitable or offensive? Report this comment

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