Lower extremity amputations (LEAs) in a tertiary hospital in Togo: a retrospective analysis of clinical, biological, radiological, and therapeutic aspects

  • Journal of Orthopaedic Surgery and Research, Volume 18, No. 1, Year 2023

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Study Justification:
– The study aimed to analyze the clinical, biological, radiological, and therapeutic aspects of lower extremity amputations (LEAs) in a tertiary hospital in Togo.
– The study provides valuable insights into the profiles and patterns of LEAs in Togo, which can contribute to improving patient care and treatment strategies.
– Understanding the factors contributing to LEAs can help in the development of preventive measures and information campaigns to address related complications.
Study Highlights:
– The study included 245 cases of LEAs in adult patients from 2010 to 2020.
– The mean age of the patients was 59.62 years, with a higher prevalence of diabetes mellitus (DM) among the cases.
– The most common amputation level was the leg, followed by the thigh, knee, and foot.
– Patients with previous LEAs were more likely to have the same limb affected.
– Trauma was a significant indication for LEAs in patients younger than 65 years.
– The mortality rate after LEA was 7.14%.
– Patients with LEAs due to trauma had longer hospital stays compared to those with non-traumatic indications.
Recommendations:
– Implement a multidisciplinary approach to address the increasing incidence of LEAs in patients with DM.
– Develop information campaigns to prevent DM, cardiovascular diseases, and related complications.
– Improve access to essential healthcare in rural areas to reduce disparities in healthcare supply and accessibility.
– Strengthen the healthcare workforce in rural areas through recruitment and training initiatives.
– Enhance trauma prevention strategies to reduce the need for traumatic LEAs.
– Focus on early detection and management of complications to improve patient outcomes.
Key Role Players:
– Medical professionals (surgeons, physicians, nurses) for patient care and treatment.
– Public health officials for implementing preventive measures and information campaigns.
– Health policymakers for developing strategies to improve healthcare access and workforce distribution.
Cost Items for Planning Recommendations:
– Recruitment and training of healthcare professionals for rural areas.
– Development and implementation of information campaigns.
– Upgrading healthcare facilities in rural areas.
– Trauma prevention programs and resources.
– Early detection and management protocols for complications.
– Monitoring and evaluation of the implemented recommendations.

The strength of evidence for this abstract is 6 out of 10.
The evidence in the abstract is based on a retrospective analysis of clinical files from a single center in Togo. While the study provides descriptive statistics and some analysis, it lacks information on the methodology, sample size, and potential biases. To improve the strength of the evidence, the study could include a clear description of the study design, sample selection criteria, and potential limitations. Additionally, providing more details on the statistical analysis methods and results would enhance the credibility of the findings.

Background: We analysed the clinical, biological, radiological profiles, and therapeutic patterns of the patients who underwent a surgical lower extremity amputation (LEA) in Togo from 2010 to 2020. Methods: Retrospective analysis of clinical files of adult patients who underwent an LEA at a single centre (Sylvanus Olympio Teaching Hospital) from 1st January 2010 to 31st December 2020. Data were analysed by CDC Epi Info Version 7 and Microsoft Office Excel 2013 software. Results: We included 245 cases. The mean age was 59.62 years (15.22 SD) (range: 15–90 years). The sex ratio was 1.99. The medical history of diabetes mellitus (DM) was found in 143/222 (64.41%) files. The amputation level found in 241/245 (98.37%) files was the leg in 133/241 (55.19%) patients, the knee in 14/241 (5.81%), the thigh in 83/241 (34.44%), and the foot in 11/241 (4.56%). The 143 patients with DM who underwent LEA had infectious and vascular diseases. Patients with previous LEAs were more likely to have the same limb affected than the contralateral one. The odds of trauma as an indication for LEA were twice as high in patients younger than 65 years compared to the older (OR = 2.095, 95% CI = 1.050–4.183). The mortality rate after LEA was 17/238 (7.14%). There was no significant difference between age, sex, presence or absence of DM, and early postoperative complications (P = 0.77; 0.96; 0.97). The mean duration of hospitalization marked in 241/245 (98.37%) files was 36.30 (1–278) days (36.20 SD). Patients with LEAs due to trauma had a significantly longer hospital admission than those with non-traumatic indications, F (3,237) = 5.505, P = 0.001. Conclusions: Compared to previous decades, from 2010 to 2020, the average incidence of LEAs for all causes at Sylvanus Olympio Teaching Hospital (Lomé, Togo) decreased while the percentage of patients with DM who underwent LEAs increased. This setting imposes a multidisciplinary approach and information campaigns to prevent DM, cardiovascular diseases, and relative complications.

This retrospective study was based on data retrieved from clinical files of adult (> 15-year-old) patients admitted and treated in the Wound Healing Unit and Traumatology-Orthopaedics department of Sylvanus Olympio Teaching Hospital (SOTH), in Lomé, the capital of Togo, from 1st January 2010 to 31st December 2020. Togo is a country in West Africa of 56,600 km2, with a population of 8,849,000 in 2022, among which 5% were above 60 years. Togo was the first country to eradicate four tropical diseases (dracuncunculiasis, lymphatic filariasis, human African trypanosomiasis, and trachoma) [22]. Togo’s health system is relatively well-equipped in terms of infrastructures, and 70.9% of the population has access to facilities. However, geographical, economic, and social disparities regarding the supply and accessibility of essential health care persist. Analysis of the distribution of human resources for health indicates that most of the health workforce is in the capital; rural areas are disadvantaged in this respect [23]. The health system in Togo is pyramidal with three levels: central, intermediate, and peripheral. The base represents the peripheral level with district hospitals, maternal and infant protection centres (PMI), and peripheral care units (USP). The middle of the pyramid represents the intermediate or regional level and corresponds to six health regions with six regional hospitals. Finally, the top of the pyramid, called the central or national level, encompasses the office of the Minister of Health, its national directions, and the three teaching hospitals. Two of the three teaching hospitals are in the capital, among which is SOTH, and one in the North of the country in Kara. The patients admitted at SOTH enrolled in the current study came from Lomé and its surrounding areas. This study was conducted according to the World Medical Association’s Declaration of Helsinki (1964, version 2013) [24], Good Clinical Practice, and approved by the medical. Institutional Board of SOTH. The drafting of the manuscript complied with the STROBE guidelines [25]. From the clinical files, we retrieved the following data: We included clinical files of all adult patients who underwent an LEA at SOTH, of both sexes. We excluded missing or incomplete clinical files. We defined the incomplete files as those with more than half of the above parameters missing. We performed a descriptive statistical analysis of the data with CDC Epi Info Version 7.2.0.1 and Microsoft Office Excel 2013 software and provided the Chi-square value, degree of freedom, Fisher test, Odds Ratio (OR), confidence interval, and cell value P, if necessary. The cell values under 5% were considered significant. We used Microsoft Office Excel 2013 software for drafting tables and figures. We used the mean value to measure the age of the patients, rate of haemoglobin, hospital stay, and duration from indication to LEA.

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Based on the provided information, it seems that the focus of the study is on lower extremity amputations (LEAs) in a tertiary hospital in Togo. The study analyzes the clinical, biological, radiological, and therapeutic aspects of patients who underwent LEAs from 2010 to 2020. The study also highlights the prevalence of diabetes mellitus (DM) among patients undergoing LEAs and the need for a multidisciplinary approach and information campaigns to prevent DM and related complications.

In terms of innovations to improve access to maternal health, it is important to note that the provided information does not directly relate to maternal health. Therefore, it is not possible to provide specific innovations for maternal health based on this study. However, there are various general innovations that can be considered to improve access to maternal health. Some potential recommendations include:

1. Telemedicine: Implementing telemedicine programs to provide remote access to healthcare services, including prenatal care and consultations, for pregnant women in remote or underserved areas.

2. Mobile health (mHealth) applications: Developing mobile applications that provide information, reminders, and guidance on prenatal care, nutrition, and maternal health to pregnant women, especially in areas with limited access to healthcare facilities.

3. Community health workers: Training and deploying community health workers who can provide basic prenatal care, education, and support to pregnant women in their communities, bridging the gap between healthcare facilities and remote areas.

4. Maternal health clinics: Establishing dedicated maternal health clinics or centers in underserved areas, equipped with necessary facilities and staffed by skilled healthcare professionals, to provide comprehensive prenatal care, delivery services, and postnatal care.

5. Transportation and referral systems: Improving transportation infrastructure and implementing efficient referral systems to ensure timely access to healthcare facilities for pregnant women in need of specialized care or emergency services.

6. Health education and awareness campaigns: Conducting targeted health education and awareness campaigns to promote maternal health, raise awareness about the importance of prenatal care, and encourage early detection and management of pregnancy-related complications.

It is important to note that these recommendations are general and may need to be tailored to the specific context and challenges faced in improving access to maternal health in Togo.
AI Innovations Description
Based on the provided information, it appears that the description you provided is related to a study on lower extremity amputations (LEAs) in a tertiary hospital in Togo. It does not directly address access to maternal health. However, if you are looking for recommendations to improve access to maternal health, here are a few suggestions:

1. Strengthen healthcare infrastructure: Invest in improving healthcare facilities, particularly in rural areas, to ensure that pregnant women have access to quality maternal healthcare services.

2. Increase the number of skilled healthcare providers: Train and deploy more skilled healthcare providers, such as doctors, nurses, and midwives, especially in underserved areas, to ensure that pregnant women have access to skilled care during pregnancy, childbirth, and postpartum.

3. Improve transportation and communication: Enhance transportation systems and communication networks to facilitate timely access to healthcare facilities for pregnant women, particularly in remote areas.

4. Promote community-based healthcare: Implement community-based healthcare programs that provide prenatal care, education, and support to pregnant women within their communities, reducing the need for long-distance travel to healthcare facilities.

5. Increase awareness and education: Conduct awareness campaigns to educate pregnant women and their families about the importance of prenatal care, skilled birth attendance, and postpartum care, as well as the available healthcare services and resources.

6. Address socio-cultural barriers: Identify and address socio-cultural barriers that prevent pregnant women from seeking and accessing maternal healthcare, such as traditional beliefs, gender norms, and stigma.

7. Improve availability and affordability of maternal healthcare services: Ensure that maternal healthcare services, including prenatal care, childbirth services, and postpartum care, are available and affordable for all women, regardless of their socio-economic status.

8. Strengthen health information systems: Develop and implement robust health information systems to collect and analyze data on maternal health indicators, enabling evidence-based decision-making and monitoring of progress.

These recommendations can serve as a starting point for developing innovative solutions to improve access to maternal health in Togo or any other context. It is important to involve key stakeholders, including healthcare providers, policymakers, community leaders, and women themselves, in the process of developing and implementing these recommendations to ensure their effectiveness and sustainability.
AI Innovations Methodology
Based on the provided information, the focus is on improving access to maternal health, so it is important to redirect the discussion towards that topic. However, if you have any specific questions or areas of interest related to maternal health, please let me know and I’ll be happy to assist you further.


Identifiers:
DOI: 10.1186/s13018-023-03628-5
Research Areas:
Disparities, Health System and Policy, Maternal and Child Health, Noncommunicable Diseases, Quality of Care, Social Determinants
Study Countries:
Multi-Countries, Togo
Study Design:
Case-Control Study, Cohort Study, Cross Sectional Study
Study Approach:
Quantitative
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