Lower limb amputation in Northern Netherlands: Unchanged incidence from 1991-1992 to 2003-2004
- Authors: Fortington, Lauren , Rommers, Gerardus , Postema, Klaas , Van Netten, Jaap , Geertzen, Jan , Dijkstra, Pieter
- Date: 2013
- Type: Text , Journal article
- Relation: Prosthetics and Orthotics International Vol. 37, no. 4 (August 2013 2013), p. 305-310
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- Description: Background: Investigating population changes gives insight into effectiveness and need for prevention and rehabilitation services. Incidence rates of amputation are highly varied, making it difficult to meaningfully compare rates between studies and regions or to compare changes over time. Study Design: Historical cohort study of transtibial amputation, knee disarticulation, and transfemoral amputations resulting from vascular disease or infection, with/without diabetes, in 2003-2004, in the three Northern provinces of the Netherlands. Objectives: To report the incidence of first transtibial amputation, knee disarticulation, or transfemoral amputation in 2003-2004 and the characteristics of this population, and to compare these outcomes to an earlier reported cohort from 1991 to 1992. Methods: Population-based incidence rates were calculated per 100,000 person-years and compared across the two cohorts. Results: Incidence of amputation was 8.8 (all age groups) and 23.6 (≥45 years) per 100,000 person-years. This was unchanged from the earlier study of 1991-1992. The relative risk of amputation was 12 times greater for people with diabetes than for people without diabetes. Conclusions: Investigation is needed into reasons for the unchanged incidence with respect to the provision of services from a range of disciplines, including vascular surgery, diabetes care, and multidisciplinary foot clinics. Clinical relevance: This study shows an unchanged incidence of amputation over time and a high risk of amputation related to diabetes. Given the increased prevalence of diabetes and population aging, both of which present an increase in the population at risk of amputation, finding methods for reducing the rate of amputation is of importance.
- Description: C1
Short and long term mortality rates after a lower limb amputation
- Authors: Fortington, Lauren , Geertzen, Jan , Van Netten, Jaap , Postema, Klaas , Rommers, Gerardus , Dijkstra, Pieter
- Date: 2013
- Type: Text , Journal article
- Relation: European Journal of Vascular and Endovascular Surgery Vol. 46, no. 1 (July 2013), p. 124-131
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- Description: Objective: To determine mortality rates after a first lower limb amputation and explore the rates for different subpopulations. Methods: Retrospective cohort study of all people who underwent a first amputation at or proximal to transtibial level, in an area of 1.7 million people. Analysis with Kaplan-Meier curves and Log Rank tests for univariate associations of psycho-social and health variables. Logistic regression for odds of death at 30-days, 1-year and 5-years. Results: 299 people were included. Median time to death was 20.3 months (95%CI: 13.1; 27.5). 30-day mortality = 22%; odds of death 2.3 times higher in people with history of cerebrovascular disease (95%CI: 1.2; 4.7, P = 0.016). 1 year mortality = 44%; odds of death 3.5 times higher for people with renal disease (95%CI: 1.8; 7.0, P < 0.001). 5-years mortality = 77%; odds of death 5.4 times higher for people with renal disease (95%CI: 1.8; 16.0,P = 0.003). Variation in mortality rates was most apparent in different age groups; people 75-84 years having better short term outcomes than those younger and older. Conclusions: Mortality rates demonstrated the frailty of this population, with almost one quarter of people dying within 30-days, and almost half at 1 year. People with cerebrovascular had higher odds of death at 30 days, and those with renal disease and 1 and 5 years, respectively.
- Description: C1
The Importance of Foot Care in Older People With Diabetes
- Authors: Fortington, Lauren , Geertzen, Jeertzen , Van Netten, Jaap , Van Baal, Jeff , Bus, Sicco , Schaper, Nicolaas
- Date: 2013
- Type: Text , Journal article
- Relation: Journal of the American Medical Directors Association Vol. 14, no. 2 (February 2013 2013), p. 136
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- Description: C1
Early post-operative mortality after major lower limb amputation : A systematic review of population and regional based studies
- Authors: Van Netten, Jaap , Fortington, Lauren , Hinchliffe, Robert , Hijmans, Juha
- Date: 2016
- Type: Text , Journal article
- Relation: European Journal of Vascular and Endovascular Surgery Vol. 51, no. 2 (2016), p. 248-258
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- Description: Objective Lower limb amputation is often associated with a high risk of early post-operative mortality. Mortality rates are also increasingly being put forward as a possible benchmark for surgical performance. The primary aim of this systematic review is to investigate early post-operative mortality following a major lower limb amputation in population/regional based studies, and reported factors that might influence these mortality outcomes. Methods Embase, PubMed, Cinahl and Psycinfo were searched for publications in any language on 30 day or in hospital mortality after major lower limb amputation in population/regional based studies. PRISMA guidelines were followed. A self developed checklist was used to assess quality and susceptibility to bias. Summary data were extracted for the percentage of the population who died; pooling of quantitative results was not possible because of methodological differences between studies. Results Of the 9,082 publications identified, results were included from 21. The percentage of the population undergoing amputation who died within 30 days ranged from 7% to 22%, the in hospital equivalent was 4-20%. Transfemoral amputation and older age were found to have a higher proportion of early post-operative mortality, compared with transtibial and younger age, respectively. Other patient factors or surgical treatment choices related to increased early post-operative mortality varied between studies. Conclusions Early post-operative mortality rates vary from 4% to 22%. There are very limited data presented for patient related factors (age, comorbidities) that influence mortality. Even less is known about factors related to surgical treatment choices, being limited to amputation level. More information is needed to allow comparison across studies or for any benchmarking of acceptable mortality rates. Agreement is needed on key factors to be reported. © 2015 European Society for Vascular Surgery.
Communication techniques for improved acceptance and adherence with therapeutic footwear
- Authors: Van Netten, Jaap , Francis, Anthony , Morphet, Ashley , Fortington, Lauren , Postema, Klass , Williams, Anita
- Date: 2017
- Type: Text , Journal article
- Relation: Prosthetics and Orthotics International Vol. 41, no. 2 (2017), p. 201-204
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- Description: Background and aim: Clients’ acceptance and adherence with orthoses can be influenced by a clinician’s communication skills. In this clinical note, we describe two communication techniques, in the context of therapeutic footwear. Technique: Person-centred communication involves engaging with and listening to the attitudes of the client towards their condition, as well as discussing acceptance and expectations, in a structured consultation. Building a relationship is crucial and requires clients to feel heard and understood. An important influence on the acceptance and adherence is that a client makes a conscious decision to receive their device. This active receipt can be facilitated through shared decision making, wherein clinicians give clear, relevant and meaningful examples, based on clinical evidence, and ensure this is understood. Discussion: Two communication techniques for clinicians providing therapeutic footwear are described. These can be adapted for use with provision of other assistive technologies to improve client acceptance and adherence. Clinical relevance: Small changes in how clinicians communicate to their clients in daily practice can have a big influence on the subsequent acceptance and adherence with therapeutic footwear and indeed other prescribed assistive technologies. © 2016, © The International Society for Prosthetics and Orthotics 2016.