Abstract
Background: Half of those undergoing major lower limb amputation for peripheral arterial disease die within one year. Advance care planning reduces days in hospital and increases the chance of dying in a preferred place.
Aim: To investigate the prevalence and content of advance care planning for people having a lower limb amputation due to acute or chronic limb threatening ischaemia or diabetes. Secondary aims were to explore its association with mortality, and length of hospital stay.
Design: A retrospective observational cohort study. The intervention was advance care planning.
Setting/participants: Patients admitted to the South West England Major Arterial Centre between 1st January 2019 and 1st January 2021 who received unilateral or bilateral below, above, or through knee amputation due to acute or chronic limb threatening ischaemia or diabetes.
Results: 116 patients. 20.7% (n=24) died within 1 year. 40.5% (n=47) had an advance care planning discussion of which all included cardiopulmonary resuscitation decisions with few exploring other options. Patients more likely to have advance care planning discussions were ≥75 years (aOR=5.58, 95%CI 1.56-20.0), female (aOR=3.24, 95%CI 1.21-8.69), and had multimorbidity (Charlson Comorbidity Index ≥5, aOR=2.97, 95%CI 1.11-7.92). Discussions occurred more often in the emergency pathway and were predominantly initiated by physicians. Advance care planning was associated with increased mortality aHR=2.63 (95%CI 1.01, 5.02) and longer hospital stay (aHR=0.52, 95%CI 0.32-0.83).
Conclusions: Despite a high risk of death for all patients in the months following amputation, advance care planning occurred in fewer than half of people and mostly focused on resuscitation.
Aim: To investigate the prevalence and content of advance care planning for people having a lower limb amputation due to acute or chronic limb threatening ischaemia or diabetes. Secondary aims were to explore its association with mortality, and length of hospital stay.
Design: A retrospective observational cohort study. The intervention was advance care planning.
Setting/participants: Patients admitted to the South West England Major Arterial Centre between 1st January 2019 and 1st January 2021 who received unilateral or bilateral below, above, or through knee amputation due to acute or chronic limb threatening ischaemia or diabetes.
Results: 116 patients. 20.7% (n=24) died within 1 year. 40.5% (n=47) had an advance care planning discussion of which all included cardiopulmonary resuscitation decisions with few exploring other options. Patients more likely to have advance care planning discussions were ≥75 years (aOR=5.58, 95%CI 1.56-20.0), female (aOR=3.24, 95%CI 1.21-8.69), and had multimorbidity (Charlson Comorbidity Index ≥5, aOR=2.97, 95%CI 1.11-7.92). Discussions occurred more often in the emergency pathway and were predominantly initiated by physicians. Advance care planning was associated with increased mortality aHR=2.63 (95%CI 1.01, 5.02) and longer hospital stay (aHR=0.52, 95%CI 0.32-0.83).
Conclusions: Despite a high risk of death for all patients in the months following amputation, advance care planning occurred in fewer than half of people and mostly focused on resuscitation.
| Original language | English |
|---|---|
| Journal | VASCULAR |
| Publication status | Accepted/In press - 14 Feb 2023 |
