Considerations for Post-operative Amputee Care

I have always enjoyed working with the amputee population. It frustrates me when I see the lack of resources and care extended to these patients following their surgeries and once discharged from the hospital. Here are some things that social workers, case managers, healthcare professionals should consider at time of discharge.

Medical/Surgical Considerations

- Wound care/ incision management - if patients continue to have wounds, make sure a referral is made to a wound care clinic or a professional dealing with wounds.

- Is the Limb length and distal end of limb appropriate for a prosthesis? If not, a conversation needs to be had with the surgical team.

- Are there any Comorbidities that will need close follow-up care? Ensure proper follow-up.

- Does the patient have appropriatePpain management to manage surgical pain and phantom pain/sensations? Again, referrals need to be made.

- Creating a post-operative team is critical for the progress of the patient. The team should consist of the Surgeon, PCP, Physiatrist/pain management specialist, orthotist and physical and occupational therapists.

Rehabilitation Needs

- Creating a rehabilitation plan is crucial. Where will they go for therapy? Options include outpatient clinics, inpatient rehabilitation facilities, subacute rehabilitaiton facilities (nursing homes with therapy).

- Ensure to Start the rehab program EARLY!

- What are the patient’s goals? What is their K level? Is the patient someone who was sedentary prior to their amuptation or were they active? What do they want to continue to do after the amputation?

- Plan for assistive devices/DME appropriate for the patient and their home. A home evaluation may be needed to determine this.

- Residual limb Conditioning and Desensitization of the DRL should be taught in therapy and with the orthotist. This is also crucial for the limb fitting into a prosthesis.

- When is the Initial Prosthetic Evaluation? Every amputee wants to know this when leaving the hospital. It is important to ensure follow-up with a prosthetic clinic.

Psychosocial/Emotional Support

- What was the patient's Psychological state pre-op and what is it now, post-op?

- Generally all amputees should receive a referral to psychologist/psychiatrist. It can then be up to them to decide if they would like to pursue this or not.

- Patient and family education about the process after the hospital discharge is important to reduce anxiety and ensure they know they will be cared for.

- Does the patient have a community support system? Especially if they don't have family in the area? The most critical is who will be their driver?

- There are all kinds of community support groups that provide peer visits, educational classes, social outings and assitance. Ensure the patients know where to find this information.

Financial/Insurance Considerations

- Does the patient have the appropriate coverage for services?

- Where can they obtain funding assistance?

- Is the patient's amputation secondary to an accident or occurence at work? Do they have access to a personal injury or worker’s compensation lawyer?

- Always ensure you have appropriate documentation when seeing the patients as they may rely on you in the future to help their cases.

Long-term Considerations

- Is the patient working at their current employment still or looking for new employment?

- Ensure you provide them with On-going resources and support groups.

- Ensure the Long-terms goals of patient will be met.

- Ensure you provide them with the Long-term prosthetic plan to reduce anxiety and help them succeed.