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Biomedical subjects

B M Persson

Publications and source records attributed to B M Persson.

At least 19 recordsLinked to original sources
PubMed1998

Cost of prostheses in patients with unilateral transtibial amputation for vascular disease. A population-based follow-up during 8 years of 112 patients.

We analyzed the cost of prostheses for patients amputated because of vascular disease. During 1 year, 112 patients were treated with a primary unilateral transtibial amputation in Malmöhus county, Sweden, which has 527,000 inhabitants. During the first 6 months after the amputation, 50% (56/112) of the patients had received a prosthesis. At 6 months, 49 patients (7 had died) were examined, 18 had poor and 31 had good prosthetic function. Within 1 year, 71 (63%) patients had been fitted with a prosthesis. During 8 years after the amputation, they received altogether 137 prostheses and 54 exchange sockets; 59% of the prostheses and 26% of the sockets were delivered during the first year. Each patient received a median of 1 prosthesis and 1 extra socket. During the 8-year period, the total cost of prostheses, sockets and maintenance for the 71 patients was USD 228,746, representing a median cost of USD 1,582 per patient. The total cost of maintenance of the prostheses during the same period was USD 37,959, representing 20% of the total cost of all the prostheses and sockets. There was no statistically significant difference in the costs between patients with good or poor function.

Adult↗
PubMed1998

Outcome after trans-tibial amputation for vascular disease. A follow-up after eight years.

All 112 patients (55 females and 57 males) with a primary unilateral trans-tibial amputation for vascular disease performed in one year at all five hospitals in Malmöhus county, Sweden were examined at 6 months according to the prosthetic function and prospectively followed-up 8 years after the amputation for survival, and prosthetic fitting. The prosthetic function was re-examined among the survivors 8 years postoperatively. At 6 months 50% were fitted with a prosthesis and later (up to 8 years) a further 13%, in total 32 females and 39 males. The mortality at 6 months was 33%, at 2 years 47% and at 8 years 92%. Age at amputation (p = 0.015), to be amputated on the left leg (p = 0.0004), to be able to walk alone outdoors before the amputation (p = 0.007) and not using a wheelchair (p = 0.02) were all found to be statistically significant predictors for receiving a prosthesis. Predictors for good function with the prosthesis 6 months postoperatively was male sex (23 of 57 vs 8 of 55 females) (p = 0.006) and greater ability to walk alone outdoors before the amputation (p = 0.01). There was no significant age difference in this comparison. The finding that it is more favourable to be amputated on the left leg merits further study.

Adult↗
PubMed1997

Improved wound healing in transtibial amputees receiving supplementary nutrition.

The objective of this prospective study of matched controls was to find out whether supplementary nutrition would improve wound healing and decrease mortality in patients undergoing transtibial amputation for occlusive arterial disease. The nutritional status of 32 consecutive transtibial amputees was assessed and 28 were classified as malnourished. Supplementary nutrition was given reaching an average intake of 2098 kcal/day for a total of 11 days. In 24 patients, at least 5 days of preoperative supplementary nutrition were given, followed by postoperative treatment for a total of 11 days. Four patients who had an immediate operation were given only postoperative treatment, and 4 were excluded. The controls were 32 amputees in another hospital and matching procedures were carried out with corrections for diabetes, sex, age, smoking habits, previous vascular surgery and living conditions before amputation. Healing, including those healed before death in both groups, occurred in 26 of the nutrition group compared to 13 in the control group, which was statistically significant. Nine patients died within 6 months in the nutrition group compared to 14 of the controls (not significant). Malnutrition was present in nearly 90% of transtibial amputees and supplementary nutrition improved healing, but not mortality.

Aged↗
PubMed1996

Operations, total hospital stay and costs of critical leg ischemia. A population-based longitudinal outcome study of 321 patients.

In a longitudinal analysis of all 321 patients in a defined population having surgery for critical leg ischemia during 1 year in Malmöhus county (0.53 million inhabitants), Sweden, we investigated all vascular procedures and amputations on both legs, total hospital stay and hospital costs from the first procedure in each patient until death or at follow-up at least 6 years postoperatively. The first (key) operation during the inclusion year was a reconstructive vascular procedure in 96 patients, a restorative vascular procedure in 111 and a major amputation in 114 patients. One third of those with a reconstructive and half of those with a restorative key procedure had an ipsilateral major amputation. The mean number of surgical procedures and length of hospital stay among all patients were 3 (1-19) procedures and 117 (1-1097) days, respectively. Of the total number of days in hospital, less than half were in surgical departments, 10% in other acute-care departments and almost half in rehabilitation clinics and nursing homes. The total hospital and surgical costs among all patients were USD 15.1 million (mean USD 47,000/patient), with no significant differences in relation to the key operation. We conclude that patients who have undergone surgery for critical leg ischemia accumulate very high total long-term hospital costs due to the need for repetitive surgery and long hospital stays. Our findings also show that a longitudinal study, including hospital stay in departments other than surgical, is necessary for a correct cost-and-outcome analysis.

Amputation, Surgical↗
PubMed1994

Gait in male trans-tibial amputees: a comparative study with healthy subjects in relation to walking speed.

Walking speed, stance duration and ground reaction forces were studied with the use of a stable force platform (Kistler) in 24 male transtibial amputees and 12 healthy subjects matched for sex and age. The aim of the study was to compare the gait performance of two groups with unilateral trans-tibial amputations for either vascular disease or trauma and also to compare the results of the two groups with the results of a group of healthy subjects. Multiple linear regression analysis was used to compare the stance duration and the ground reaction forces in relation to walking speed. The vascular and traumatic amputees had significantly reduced walking speeds compared with the healthy subjects, 0.85 +/- 0.2 m/s and 0.99 +/- 0.2 m/s. respectively, as compared to 1.42 +/- 0.2 m/s. By comparing the vascular and traumatic amputees with the healthy subjects in relation to walking speed, it was shown that the gait performance of the vascular amputee differed from that of the traumatic amputee, a difference that was not caused by the reduced walking speed. The active forces during push off on both the healthy (p = 0.02) and the prosthetic leg (p = 0.003) in the trauma group were not found in the vascular group. This disparity could be an effect of the systemic disease. It may be argued that the results of this study contribute to the understanding of the reduced walking ability of the vascular amputee and should be borne in mind when planning rehabilitation.

Aged↗
PubMed1994

Standing balance in trans-tibial amputees following vascular disease or trauma: a comparative study with healthy subjects.

Standing balance measured as sway and standing time both on one and two legs, was studied by use of a stable force platform (Kistler) in 36 patients aged 48-87 years with trans-tibial amputation and 27 healthy subjects matched for age. The aim of the study was to compare postural function in standing in two groups with unilateral trans-tibial amputations, separating vascular disease from trauma. Results revealed that the vascular group had a significantly increased sway in the lateral direction compared with the healthy group, when standing on both feet close together for 30 seconds, looking straight ahead or blindfolded (p values ranging from 0.003 to 0.02). In the sagittal direction the trauma amputees had a significantly decreased sway when looking straight ahead, compared to the vascular and healthy groups (p values = 0.03). No significant differences in the lateral or sagittal direction were seen among the three groups when comparing standing on one leg. There was a significant difference, however, in the standing time in the one-leg standing test of the vascular group when compared with the trauma and healthy groups (p values ranging from 0.0009 to 0.02). In contrast to the vascular group, all subjects in the trauma and healthy groups from 48 to 59 years could stand on the healthy leg for 30 seconds when looking straight ahead, and from 60 to 79 years they could stand for 5 seconds. None in the vascular or trauma group older than 80 years could stand on the healthy leg for 5 seconds.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1993

Risk factors for failed healing in amputation for vascular disease. A prospective, consecutive study of 177 cases.

We examined factors which may lower the mean amputation age and factors which may serve as predictors of success or failure of amputations in the lower extremities for vascular disease in 177 consecutive amputees. Smoking lowered the mean amputation age by 9 years and diabetes by 3 years. Preoperative absence of gangrene in the ischemic limb predicted a higher risk of failure compared to patients with gangrene. Also preoperative hemoglobin > 120 g/L gave a higher risk of failure. Failure to heal was not correlated with age, sex, diabetes, level of amputation, previous vascular surgery, smoking, preoperative blood pressure, serum creatinine, erythrocyte sedimentation rate, blood glucose or temperature.

Adult↗
PubMed1993

Fracture of the lateral malleolus. Comparison of 2 fixation methods in cadavers.

20 pairs of lateral malleolar fracture were created by an osteotome at autopsy of elderly patients and repaired on one side with staples and cerclage wire and on the other side with plate and screws. The stability of the fixation was then tested in an apparatus creating outward rotational load. The breaking load in fractures fixated with staples and wire was about 60 percent (18 SD 7.6 Nm) of the plated fibular fractures (32 SD 11 Nm). However, at an outward deflection up to 30 degrees there was no difference in breaking load with the two methods of fixation.

Aged↗
PubMed1992

Amputation for occlusive arterial disease. A prospective multicentre study of 177 amputees.

All major amputations of the lower limb due to occlusive arterial disease were studied prospectively and consecutively during one year in the 5 hospitals in Malmöhus county, Sweden. The patients were followed for 6 months after the primary amputation of which 136 were through the tibia, 6 through the knee and 35 through the femur. One hundred and seventy-seven patients (92 men and 85 women) were included; 49% were 80 years or older and 40% were diabetic. At 6 months, 85 of the surviving 109 patients had healed stumps, 10 were not healed and 14 had been revised or reamputated. Half the survivors used a prosthesis daily. There was no significant difference in healing related to sex, age, diabetes or the level of amputation, but diabetics were more often bilateral amputees. The mortality at 6 months was 38% and at 4 years 72%.

Adult↗