INPATIENT LENGTH OF STAY AND FINANCIAL IMPLICATIONS FOLLOWING ABOVE & BELOW KNEE AMPUTATIONS Farhan...
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Transcript of INPATIENT LENGTH OF STAY AND FINANCIAL IMPLICATIONS FOLLOWING ABOVE & BELOW KNEE AMPUTATIONS Farhan...
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INPATIENT LENGTH OF STAY AND FINANCIAL IMPLICATIONS FOLLOWING ABOVE & BELOW
KNEE AMPUTATIONS
Farhan Hussain, Jason George, Ben Banerjee, Paul Dunlop, Klaus Overbeck, Shanmugam Vetrivel, Andrew Brown
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Background
• No clearly defined length of stay post amputation
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• Royal Derby Hospital (March- November 2009) postoperative LoS 19.6 days (range 5-47)
• Duke University Hospital- 1 yr period LoS 11.1+/-7.04 days reduced to 9.61 +/-6.37 increased use of MDT approach/efficiency
• Singapore study: able to reduce LoS from 23.16 to 17.8 days through use of the LEAP programme
More facts and figures…
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Aim
Identify factors leading to unnecessarily long
postoperative LoS
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Selection criteria
• AKA • BKA• Last 50 amputations• Exclude current inpatients• Patients died post operatively
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Methodology
• Total LoS• Post-operative LoS• LoS once medically fit • Post-operative and non-operative issues• Cost of prolonged LoS
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Limitations
• Only 20 case notes available• Difficult to find reasons for delay e.g. social
reasons• Not all data transferred to computerised
records
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Results• 27 AKAs and 23 BKAs• 59.54 Total Los and 42.2 days Post op LoS• LoS once medically fit 17.17 days = £2692.76• Total cost £48469.74
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Contributing factors
• Surgical Issues– Complications (60%)– Further treatment (50%)– Wound (40%)
• Non Operative Issues (dominate once MFFD)– Housing (40%)– OT equipment (45%)– Further rehab (25%)– Other social/care (25%)
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Conclusion
Non-medical issues are the major factors prolonging LoS. Novel and effective strategies
are required to minimise delays involving social planning and discharge with the involvement of
key stakeholders.
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Suggestions
• Prolonged LoS multifactorial• Where possible early referral to OT/social work
prior to hospital admission• Early referral to pain team to help reduce effect of
post operative pain• Build nutrition/strength prior to amputations • Collapsible side arms on chairs to aid transfers
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