Lower extremity amputations (LEAs) in a tertiary hospital in Togo: a retrospective analysis of clinical, biological, radiological, and therapeutic aspects

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Abstract

Background

We analysed the clinical, biological, radiological profiles, and therapeutic patterns of the patients who underwent a surgical lower extremity amputation (LEA) in Togo from 2010 to 2020.

Methods

Retrospective analysis of clinical files of adult patients who underwent an LEA at a single centre (Sylvanus Olympio Teaching Hospital) from 1st January 2010 to 31st December 2020. Data were analysed by CDC Epi Info Version 7 and Microsoft Office Excel 2013 software.

Results

We included 245 cases. The mean age was 59.62 years (15.22 SD) (range: 15–90 years). The sex ratio was 1.99. The medical history of diabetes mellitus (DM) was found in 143/222 (64.41%) files. The amputation level found in 241/245 (98.37%) files was the leg in 133/241 (55.19%) patients, the knee in 14/241 (5.81%), the thigh in 83/241 (34.44%), and the foot in 11/241 (4.56%). The 143 patients with DM who underwent LEA had infectious and vascular diseases. Patients with previous LEAs were more likely to have the same limb affected than the contralateral one. The odds of trauma as an indication for LEA were twice as high in patients younger than 65 years compared to the older (OR = 2.095, 95% CI = 1.050–4.183). The mortality rate after LEA was 17/238 (7.14%). There was no significant difference between age, sex, presence or absence of DM, and early postoperative complications ( P = 0.77; 0.96; 0.97). The mean duration of hospitalization marked in 241/245 (98.37%) files was 36.30 (1–278) days (36.20 SD). Patients with LEAs due to trauma had a significantly longer hospital admission than those with non-traumatic indications, F (3,237) = 5.505, P = 0.001.

Conclusions

Compared to previous decades, from 2010 to 2020, the average incidence of LEAs for all causes at Sylvanus Olympio Teaching Hospital (Lomé, Togo) decreased while the percentage of patients with DM who underwent LEAs increased. This setting imposes a multidisciplinary approach and information campaigns to prevent DM, cardiovascular diseases, and relative complications.

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Most cited references 39

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A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation

Mary Charlson, Peter Pompei, Kathy Ales … (1987)

The objective of this study was to develop a prospectively applicable method for classifying comorbid conditions which might alter the risk of mortality for use in longitudinal studies. A weighted index that takes into account the number and the seriousness of comorbid disease was developed in a cohort of 559 medical patients. The 1-yr mortality rates for the different scores were: "0", 12% (181); "1-2", 26% (225); "3-4", 52% (71); and "greater than or equal to 5", 85% (82). The index was tested for its ability to predict risk of death from comorbid disease in the second cohort of 685 patients during a 10-yr follow-up. The percent of patients who died of comorbid disease for the different scores were: "0", 8% (588); "1", 25% (54); "2", 48% (25); "greater than or equal to 3", 59% (18). With each increased level of the comorbidity index, there were stepwise increases in the cumulative mortality attributable to comorbid disease (log rank chi 2 = 165; p less than 0.0001). In this longer follow-up, age was also a predictor of mortality (p less than 0.001). The new index performed similarly to a previous system devised by Kaplan and Feinstein. The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death from comorbid disease for use in longitudinal studies. Further work in larger populations is still required to refine the approach because the number of patients with any given condition in this study was relatively small.

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Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.

Daniel Dindo, Nicolas Demartines, Pierre-Alain Clavien (2004)

Although quality assessment is gaining increasing attention, there is still no consensus on how to define and grade postoperative complications. This shortcoming hampers comparison of outcome data among different centers and therapies and over time. A classification of complications published by one of the authors in 1992 was critically re-evaluated and modified to increase its accuracy and its acceptability in the surgical community. Modifications mainly focused on the manner of reporting life-threatening and permanently disabling complications. The new grading system still mostly relies on the therapy used to treat the complication. The classification was tested in a cohort of 6336 patients who underwent elective general surgery at our institution. The reproducibility and personal judgment of the classification were evaluated through an international survey with 2 questionnaires sent to 10 surgical centers worldwide. The new ranking system significantly correlated with complexity of surgery (P < 0.0001) as well as with the length of the hospital stay (P < 0.0001). A total of 144 surgeons from 10 different centers around the world and at different levels of training returned the survey. Ninety percent of the case presentations were correctly graded. The classification was considered to be simple (92% of the respondents), reproducible (91%), logical (92%), useful (90%), and comprehensive (89%). The answers of both questionnaires were not dependent on the origin of the reply and the level of training of the surgeons. The new complication classification appears reliable and may represent a compelling tool for quality assessment in surgery in all parts of the world.

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Author and article information

Contributors

T. E. Kouevi-Koko:

ORCID: https://orcid.org/0000-0001-9003-5992

edem.kouevikoko@gmail.com

Journal

Journal ID (nlm-ta): J Orthop Surg Res

Journal ID (iso-abbrev): J Orthop Surg Res

Title: Journal of Orthopaedic Surgery and Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1749-799X

Publication date (Electronic): 2 March 2023

Publication date PMC-release: 2 March 2023

Publication date Collection: 2023

Volume: 18

Electronic Location Identifier: 155

Affiliations

[1 ]GRID grid.12364.32, ISNI 0000 0004 0647 9497, Burn and Wound Healing Unit, Faculté des Sciences de la Santé, , University of Lomé, ; Lomé, Togo

[2 ]GRID grid.12364.32, ISNI 0000 0004 0647 9497, Department of General Surgery, Faculté des Sciences de la Santé, , University of Lomé, ; Lomé, Togo

[3 ]GRID grid.12364.32, ISNI 0000 0004 0647 9497, Laboratory of Human Anatomy, Faculté des Sciences de la Santé, , University of Lomé, ; Lomé, Togo

[4 ]GRID grid.12364.32, ISNI 0000 0004 0647 9497, Department of Geriatrics, Faculté des Sciences de la Santé, , University of Lomé, ; Lomé, Togo

[5 ]GRID grid.12364.32, ISNI 0000 0004 0647 9497, Traumatology-Orthopaedics Department, Faculté des Sciences de la Santé, , University of Lomé, ; Lomé, Togo

[6 ]GRID grid.12364.32, ISNI 0000 0004 0647 9497, General Surgery, Faculté des Sciences de la Santé, , University of Lomé, ; Lomé, Togo

[7 ]Sylvanus Olympio Teaching Hospital, Lomé, Togo

Author information

T. E. Kouevi-Koko https://orcid.org/0000-0001-9003-5992

K. S. Amouzou https://orcid.org/0000-0003-0321-826X

A. Sogan https://orcid.org/0000-0002-4089-5991

S. Apeti https://orcid.org/0000-0001-6090-638X

Y. E. L. Dakey https://orcid.org/0000-0001-9510-3413

A. Abalo https://orcid.org/0000-0003-4797-3777

Article

Publisher ID: 3628

DOI: 10.1186/s13018-023-03628-5

PMC ID: 9979402

PubMed ID: 36864481

SO-VID: c716a807-6f17-40bb-a9ee-765a0f83bf7e

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 13 October 2022

Date accepted : 19 February 2023

Custom metadata

ScienceOpen disciplines: Surgery

Keywords: amputation,lower extremity,diabetes mellitus,diabetic foot,togo

Data availability:

ScienceOpen disciplines: Surgery

Keywords: amputation, lower extremity, diabetes mellitus, diabetic foot, togo

Lower extremity amputations (LEAs) in a tertiary hospital in Togo: a retrospective analysis of clinical, biological, radiological, and therapeutic aspects

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Abstract

Background

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Conclusions

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25th European Students' Conference

Most cited references 39

World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.

A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation

Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.

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