Risk Factors Associated with Limb Amputation in a Referral Hospital in Benue State Nigeria

Background: Trauma, diabetes mellitus and peripheral vascular disease are age old known risk factors associated with amputation. However, at the Nongu Kristi U Sudan hen Tiv (NKST) Rehabilitation hospital, Mkar, Gboko, Benue state Nigeria, HIV/AIDS is increasingly becoming a major risk factor for upper limb amputation, and this is investigated in this study.

Objectives: To determine the risk factors involved in amputation in a referral hospital located in Benue State Nigeria.

Methods: A Descriptive cross sectional study design was adopted for this study where the pre-operative assessments for HIV testing, serum Fasting Blood Sugar (FBS) level, Full Blood Count (FBC), CD4 counts, Hepatitis B and C antigens were carried out using standard laboratory investigation techniques. Dopplar ultrasonographic assessment of the affected limb was done preoperatively to determine the nature and level of vascular obstruction while post-operative histocytology of the amputated stump was performed to determine the pathology at the Benue State University. Data obtained were entered into a profoma already designed for the study while statistical analysis was performed with the aid of SPSS (Version 20) with level of significance set at 95%.

Results: A total of 60 patients booked for amputation within the study period were enrolled for this study. Majority were Males 41 (68.3%), out of which amputation cases in individuals below 10 years of age were mainly due to trauma (8.3%). The age range of 21-40 years recorded the highest number of amputations 24 (40%). In the female patients, trauma was responsible for 8 (42.1%) cases while HIV was associated with 1 (5.3%) of all amputations. In males trauma and HIV/AIDS were indications in 25 (61%) and 10 (24.4%) respectively. Other risks factors in males responsible for amputation were diabetes 2 (4.9%) and vascular diseases 1 (2.4%). In females, diabetes mellitus was associated with 6 (31.5%) of amputations. There is a statistically significant difference in the indication for limb amputation in male and female patients where HIV/AIDS was significantly higher in males 10 (24.4%) than in females (x2 = 13.1; p= 0.01). Lower limbs 49 (81.7%) amputations were more than upper limbs 11 (18.3%) amputations. This study revealed that HIV/AIDS ranked second as an indication for upper limb amputations although trauma was the main indication for most upper limb amputations.

Conclusion: This study showed that trauma remains the predominant risk factor for amputation, however HIV/AIDS is emerging as a major indication for upper limb amputation.