Lower extremity amputation in Hong Kong

MWN Wong
Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong

OBJECTIVE. To evaluate the characteristics and outcome of patients undergoing lower extremity amputation in Hong Kong.

DESIGN. Cohort study.

SETTING. University teaching hospital, Hong Kong.

PARTICIPANTS. One hundred and eighty-four Chinese adults who underwent lower extremity amputation.

MAIN OUTCOME MEASURES. Demographic data of the cohort, wound complication and revision amputation rates, prosthesis use, functional ambulation level and institutionalisation at postoperative 6 months, operative mortality, and long-term survival.

RESULTS. The majority of patients (83.1%) who underwent lower extremity amputation were aged over 60 years. Vascular occlusive disease was the most common underlying pathology, followed by infection. The wound complication and operative mortality rates were high. Only 43.0% of patients were able to resume community ambulation at 6 months and 40.7% became institutionalised. After high-level amputations, 22.3% managed to use a prosthesis. The median survival after lower extremity amputation was 1008 days. High-level amputation was associated with lower wound complication and revision amputation rates, but an inferior functional outcome and survival compared with foot amputation.

CONCLUSIONS. Lower extremity amputation is associated with high morbidity and mortality, especially with high-level amputations. It places a heavy burden of care on patients, their families, the health care system, and society. Appropriate health care planning, provisions, and coordinated efforts at various levels are necessary to improve the situation. Major efforts must also be focused on preventing vascular occlusive disease and diabetes.

Hong Kong Med J 2005;11:147-52

Key words: Amputation; Chinese; Mortality; Treatment outcome