Causal conditions for major limb amputation at a specialist hospital in north central Nigeria

Background: Amputation is said to be a mutilating surgical procedure with causes varying within and between countries. Even though most causes of amputation result from potentially preventable conditions, it is one of the most commonly performed procedures. The aim of this study is to elucidate the of causes of major limb amputation at NKST Rehabilitation Hospital, Mkar , Benue State so as to proffer preventive measures.Methodology: Case records of patients who had major limb amputation between January 2007 and December 2011 at NKST Rehabilitation Hospital, Mkar, were retrieved from the Medical Records Department and analyzed for age at time of amputation, gender, indication for amputation, and early complications following surgery.Results: A total of 198 major limb amputations in 198 patients were audited. There were 139(70.2%) males and 59(29.8%) females with an age range of 2-85 years. The causes of major limb amputation included trauma (n=122, 61.6%), diabetic foot disease (n=36, 18.2%), musculoskeletal tumours (n=26, 13.1%) and peripheral vascular disease (unrelated to diabetes) (n=10, 5.1%). Traditional bone setters' gangrene was the predominant cause (n=65, 53.3%) of traumatic amputation. Surgical site infection was the leading early complication(n=63, 31.8%).Conclusion: Trauma and diabetic foot disease were the leading causes of major limb amputation from the study. Regulating traditional bone setters' practices, enforcing road safety regulations and adequate diabetic foot care practices are recommended.Keywords: Major limb amputation, Indications, TraumaJos Journal of Medicine, Volume 7 No.

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely