{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T17:08:30Z","timestamp":1791479310619,"version":"4.3.4"},"reference-count":19,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,1,2]],"date-time":"2020-01-02T00:00:00Z","timestamp":1577923200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2020,1,2]],"date-time":"2020-01-02T00:00:00Z","timestamp":1577923200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2020,1,2]],"date-time":"2020-01-02T00:00:00Z","timestamp":1577923200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Rapid urbanization and westernization have precipitated dramatic changes in the profile and prevalence of surgical diseases in sub\u2010Saharan Africa. Disease of lifestyle is now common. We aimed to review our experience with lower\u2010limb amputations at our surgical service in South Africa.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A single\u2010center retrospective review of a prospectively collected database was performed of all patients who underwent a lower limb amputation. Inferential and descriptive statistics were performed. Patient demographics, indication, type of amputation, and management were reviewed. The primary outcome was 30\u2010day in\u2010patient mortality rate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Over a 5\u2010year period (2013\u20132018), 348 patients underwent lower limb amputations. The median age was 61.5 years. 53.7% were diabetic and 56.3% were hypertensive. 53.2% had associated peripheral vascular disease and 8% preexisting cardiac disease. 30.7% smoked. Guillotine below\u2010knee amputation was frequently performed (44.5% of amputations). 16.1% of these patients required a further operation. The in\u2010hospital mortality rate was 8%. Underlying renal disease was an independent risk factor for mortality (<jats:italic>p<\/jats:italic>\u2009=\u20090.004).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Currently, the most common indications for LLA in South Africa are diabetes mellitus and atherosclerosis. This reflects the changing pattern of disease in the country. There is a major problem with access to health care in rural areas in South Africa with significant delays in getting patients to tertiary units for evaluation by specialists. Foot care and prevention at a primary health care level is also lacking. Global improvements in the healthcare system are needed to improve LLA rates in South Africa.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-019-05361-9","type":"journal-article","created":{"date-parts":[[2020,1,2]],"date-time":"2020-01-02T19:05:58Z","timestamp":1577991958000},"page":"1436-1443","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Evolving Indications for Lower Limb Amputations in South Africa Offer Opportunities for Health System Improvement"],"prefix":"10.1002","volume":"44","author":[{"given":"Muhammad Zafar","family":"Khan","sequence":"first","affiliation":[{"name":"Department of General Surgery and Trauma Greys Hospital Pietermaritzburg Metropolitan Complex Pietermaritzburg South Africa"},{"name":"Department of Surgery University of KwaZulu Natal Durban South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle TD","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Trauma Greys Hospital Pietermaritzburg Metropolitan Complex Pietermaritzburg South Africa"},{"name":"Department of Surgery University of KwaZulu Natal Durban South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John L","family":"Bruce","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Trauma Greys Hospital Pietermaritzburg Metropolitan Complex Pietermaritzburg South Africa"},{"name":"Department of Surgery University of KwaZulu Natal Durban South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor Y","family":"Kong","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Witwatersrand Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damian L","family":"Clarke","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Trauma Greys Hospital Pietermaritzburg Metropolitan Complex Pietermaritzburg South Africa"},{"name":"Department of Surgery University of KwaZulu Natal Durban South Africa"},{"name":"Department of Surgery University of Witwatersrand Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,1,2]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(09)61087\u20104"},{"issue":"8","key":"e_1_2_11_3_1","first-page":"700","article-title":"Estimating the burden of disease attributable to diabetes in South Africa in 2000","volume":"97","author":"Bradshaw D","year":"2007","journal-title":"S Afr Med J"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0043336"},{"key":"e_1_2_11_5_1","unstructured":"Youth explorer organization census 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Referral Hospital, Mekelle, Ethiopia: a three\u2010year experience","volume":"28","author":"Gebreslassie B","year":"2018","journal-title":"J Health Sci"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/1749\u2010799X\u20107\u201018"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.4314\/ahs.v17i2.26"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.4103\/aam.aam_40_17"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1479\u2010666X(07)80006\u20100"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2018.1059"},{"issue":"2","key":"e_1_2_11_17_1","first-page":"41","article-title":"A Five\u2010year audit of lower limb amputations below the knee and rehabilitation outcomes: the Durban experience","volume":"24","author":"Manickum P","year":"2018","journal-title":"J Endocrinol Metab Diabetes S 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January 2020","order":1,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors do not have any relevant disclosures or conflicts of interest in this work.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}