SRS99 - An audit assessing the surgical outcomes of Major Lower Limb Amputation (MLLA) in south tyneside and Sunderland NHS foundation trust

Abstract This audit evaluates peri-operative care and outcomes for patients undergoing major lower limb amputation (MLLA) at Sunderland Royal Hospital between August 2024 and March 2025. MLLA, defined as any amputation above the ankle, is a critical intervention primarily for patients with chronic limb-threatening ischemia (CLTI) and diabetic foot infections (DFI). The audit assessed compliance with national standards from the Vascular Society of Great Britain and Ireland (VSGBI) and the National Confidential Enquiry into Patient Outcome and Death (NCEPOD), focusing on consultant review timing, operative timing, prophylaxis, multidisciplinary team involvement, and patient outcomes. Data from 45 eligible MLLA cases revealed full compliance with consultant review within 24 h, antibiotic and venous thromboembolism (VTE) prophylaxis, and physiotherapy involvement during admission. However, only 67% of amputations occurred within 48 h of decision, and just 45% of diabetic patients received specialist diabetes team input. The below-knee to above-knee amputation ratio was 2:1, meeting best practice standards. Post-operative stump complications occurred in 20% of patients, with a 30-day mortality rate of 2.2%. The average hospital stay was prolonged at 34 days, with nearly half of patients remaining hospitalized beyond 30 days, highlighting potential inefficiencies in discharge planning and rehabilitation. The audit recommends improved diabetic specialist engagement through a blanket referral policy or weekly multidisciplinary ward rounds and enhanced physiotherapy input pre- and post-operatively to optimize rehabilitation and expedite discharge. These measures may reduce post-operative complications and length of stay, ultimately improving patient outcomes and reducing healthcare costs.