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Abstract

Aim:
The purpose of this thesis was to understand and predict functional outcome after major lower limb amputation in vascular surgery, and to incorporate these findings into validated risk prediction tools to aid pre-operative decision making.

Methods:
The thesis utilised qualitative and quantitative methodologies and comprised six experimental chapters including systematic reviews, cross-sectional studies, and cohort studies. In addition, two supplementary experiments were included, each further exploring a novel finding from the core experiments. Construction of four databases enabled the exploration of health-related concerns of patients and the prediction of peri-operative, rehabilitation and palliative outcomes in patients with an unsalvageable limb.

Results:
Current lower limb interventions do not address the concerns of patients. A systematic review found that only 1/38 studies, assessing outcomes of multidisciplinary care, reported on a functional outcome. In contrast, psychosocial exploration of 76 patients showed that functional outcome before and after limb loss was their chief concern.

In a study of 262 amputees, a significant proportion of amputees (17.1%) did not progress to a stage of recovery that enabled rehabilitation post-amputation. Functional outcome remained unacceptably poor after specialist rehabilitation. In a regional study of 807 rehabilitees, only half of patients achieved independent prosthetic mobility. Active cancer was consistently a poor prognostic factor for functional outcome.

Palliation for the unsalvageable limb remains poorly understood and implemented. A study on 66 cases revealed that survival varies significantly with the aetiology of the unsalvageable limb, and that currently, we fail to meet expectations of dying patients.

Risk prediction models for functional outcomes were internally validated and incorporated in a web-based application for ease of clinical utility.

Conclusion:
In conclusion, findings showed that it is possible to predict functional outcome reliably, thus addressing the chief concern of patients facing limb loss, and to use such prediction tools to aid pre-operative decision making.

Publication Type:	Thesis (Doctoral)
Subjects:	R Medicine > R Medicine (General) R Medicine > RD Surgery
Departments:	School of Health & Medical Sciences > Cardiovascular and Genomics Research Institute School of Health & Medical Sciences > School of Health & Medical Sciences Doctoral Theses Doctoral Theses

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