The Scope of Non-Trauma Lower Limb Amputations at the Komfo Anokye Teaching Hospital, Kumasi-Ghana

Abstract

Background: Lower limb amputation has a significant impact on the quality of life of the affected individual and family. Non-trauma amputations are the result of neglected public health conditions like complications of Diabetes mellitus, peripheral arterial disease and malignancies. The incidence of non-trauma amputation is increasing in Ghana mainly due to these non-communicable diseases which can be ascribed partially to changing lifestyles. Objective: The objective of this study is to determine the demographic profile of non-trauma amputees, indications and patterns of amputation, duration of symptoms before reporting to hospital, reasons for delay in seeking medical care, and length of hospital stay from admission to discharge. Methods: A prospective cross sectional study was carried out at the General Surgery Unit of the Komfo Anokye Teaching Hospital from November 2012 to October 2014. All patients on admission who had undergone lower limb amputation for non-trauma indications were interviewed using structured questionnaire. Their clinical notes were used to collect extra information on clinical management data to satisfy the set objectives. Data was analyzed with Epi Info version 3.5.1. Results were presented using simple descriptive statistics. Ethical clearance was obtained from CHRPE. Results: A total of 104 patients underwent amputation for non-trauma indications during the period under study. The mean age of respondents was 65years ± 14.7 SD with a Male: Female ratio of 1.6:1. Majority; 85 (81.7%) had either no formal education or only primary education while 71 (68.3%) were employed in the informal sector (mainly farmers, artisans and traders). Twenty three (22.1%) were unemployed and 1 (0.9%) was a student. The indications for non-trauma amputations were diabetic leg ulcers; 55 (52.9%), peripheral arterial disease; 42 (40.4%), malignancies; 6 (5.7%), and post-burn contracture; 1 (0.9%). The pattern of amputation were above knee amputation; 64 (61.5%), below knee amputation; 23 (22.1%), Rays amputation of the toe; 15 (14.4%) and 2 (1.9%) Hip de-articulation. Sixteen (15.4%) presented within 3 months of onset of symptoms, while 57 (54.8%) presented between 3-6 months and 31 (29.8.0%) after 6 months. Reasons for delayed presentation were: home treatment with herbs; 43 (41.3 %), fear of having limbs amputated; 25 (24.0%), financial constraints; 16 (15.4%), lack of nearby health facilities; 5 (5.4) % and others. The duration of hospital stay was from 4 - 86 days with a mean of 17.53 ±14.83SD. Conclusion and Recommendation: This study concluded that complications of diabetes mellitus were the major indication for non-trauma amputations in KATH. Above knee amputation was the commonest pattern of amputation. Majority of patients presented between 3-6 months of onset of symptoms. Commonest reason for delayed presentation to hospital was the preference of herbal medications to hospital treatment. Duration of hospital stay from admission to discharge was approximately 5 weeks. It is recommended from evidence gathered from this study that proper attention should be given to improving the awareness and quality of care of diabetes mellitus to minimize its complications leading to non-trauma amputations