TPTh 5.04 Prosthetic use post Major Lower Limb Amputation in Vascular Surgery Patients

Abstract

Aim of study was to analyse Below knee amputation vs Through knee amputation for factors associated with prosthesis provision in a tertiary vascular centre. Hypothesis Prosthetic use after MLLA results in better quality of life and survival. Retrospective review of consecutive patients undergoing major lower limb amputation between 2022-2023 (n = 182). Demographics, comorbidities, amputation level, revascularisation history, HbA1c and preoperative functional status (BLART/BAMS) were recorded. Prosthetic use, length of stay and mortality were captured, and service-level barriers including distance, transport and satellite care involvement also. Categorical variables were compared with Fisher’s exact test and continuous variables with the Wilcoxon rank-sum test. Variables with p < 0.1 on univariate testing were entered into multivariable logistic regression to identify predictors of prosthetic fitting. Median age 63 years; 83% male. Prosthetic fitting occurred in 47.8% (87/182). BKA patients more frequently received prostheses than TKA (50.3% vs 26.3%; p≈0.08). Thirty-eight deaths (20.9%) were recorded; BKA mortality 20.2%, TKA mortality 26.3%. Prosthesis rates were higher after open and endovascular revascularisation; hybrid procedures had higher mortality. On multivariable analysis female sex was independently associated with lower odds of prosthetic fitting (OR 0.35, 95% CI 0.12–0.91, p=0.04); BLART score showed a non-significant trend (OR 0.91 per point, p≈0.08). Under half of patients received a prosthesis after MLLA. Female sex and reduced preoperative mobility were associated with lower provision. Targeted pathways to improve rehabilitation access and equity are recommended and further prospective evaluation is warranted.