Mobility Rates After Lower-Limb Amputation for Patients Treated with Physician-Led Collaborative Care Model

BACKGROUND

Clinical outcomes after major lower-limb amputation have been historically poor. The current care provided to most amputees is often disorganized and without physician supervision. The primary purpose of this study is to examine rates of postamputation mobility achieved with a prosthesis by patients with chronic limb-threatening ischemia and/or diabetes who required major lower-limb amputation and were treated under an established physician-led collaborative care pathway. The secondary purpose is to describe the structure and utilization of the care pathway by multiple independent vascular surgery practices in the United States to enable future exploration of its impact on key clinical outcomes within this patient population.

METHODS

Clinical records of 2,475 patients from 6 vascular practices that adopted this collaborative care pathway between 2017 and 2020 were retrospectively reviewed. Only records with sufficient documented histories of amputation surgeries, prosthetic services, and mobility status were included.

RESULTS

Of 2,475 patient records reviewed, 1,787 patients (2,157 major amputations) were eligible for analysis. Sixty-two-point 2 percent (n = 1,111) of patients achieved mobility with the collaborative care pathway. Mobility rate varied by amputation level in the study. Prosthetic mobility was achieved in 73.5% of transtibial amputations, 40.4% of transfemoral amputations, and 35.7% of through-knee amputations, regardless of patient laterality, which is superior or equivalent to the best published rates of mobility.

CONCLUSIONS

The study describes the structure and utilization of a physician-led collaborative care pathway for treating patients who require lower-limb amputation that meets 5 of the 7 recommendations from the 2019 Global Vascular Guidelines on the Management of Chronic Limb Threatening Ischemia. Internal data analysis results suggest that patients treated via this care pathway can potentially achieve improved mobility rates with a prosthesis following amputation. This collaborative care pathway should be further evaluated for its ability to directly improve mobility and other clinically relevant amputation outcomes.

Idiopathic thrombocytopenic purpura complicating chronic lymphocytic leukemia

Three patients had severe, symptomatic idiopathic thrombocytopenic purpura (ITP) complicating chronic lymphocytic leukemia (CLL) that was refractory to prednisone treatment but that responded to splenectomy alone or in addition to immunosuppressive-cytotoxic treatment. Evidence of high titer of an antiplatelet factor, most likely an antibody, was corroborated in one case by the 14C-platelet serotonin release assay. This experience suggests that the treatment of ITP complicating CLL is similar to that of ITP not associated with lymphoproliferative disorders.