Falls during index hospital stay and reoperations due to falls in lower limb amputees
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Background and purpose: Major lower limb amputations (MLLA) is here defined as an amputation above the ankle. Such amputations are most often performed due to ischemia, osteomyelitis and trauma. The objective of this study was to find the incidence of falls following a MLLA at St. Olav’s University Hospital. It sought to identify who’s at risk of falling and further the occurrence of reoperations due to falls. Material and methods: This is a single-center retrospective cohort study with prospectively collected data. It included patients with a primary amputation operated between 2005 and 2015 at St. Olav’s University Hospital. Infants were excluded. Age at amputation, gender, diabetes mellitus, indication for and level of amputation, and reoperations were retrieved from the electronical medical records. Further, all falls, including those who lead to reoperations, were documented. The time from primary operation to reoperations and death, and type of procedure during subsequent surgeries were also retrieved. For inpatients with a fall during their index hospital stay, cognitive impairment and selected drugs (benzodiazepines, opiates, opium derivatives, antiepileptics, neuroleptics, diuretics) were registered. Results: 459 patients with a total of 533 primary amputations were identified. The median (percentiles) follow-up was 21 (4, 54) months. At primary amputation, the median (percentiles) age was 78 years (66, 84). Two thirds of the patients included were men. The overall median (95 % CI) estimated survival following the primary amputation was 26 months (19, 33). 102 patients endured a fall after the amputation, 72 % of these during the index hospital stay. Male gender and a transtibial level of amputation increased the risk of falling. Thirteen patients had a reoperation as a direct consequence to the fall, and all of them had ischemia as indication for primary amputation. Interpretation: The incidence of falls amongst amputees during the index hospital stay is low in our hospital. Nevertheless, particular attention should be made to ensure efforts are taken to prevent male patients and patients who have been amputated at the transtibial level from falling.