Work

Quality of care using nursing-sensitive indicators in major lower extremity amputation patients: Insights from the Kolding KOhort (KOKO) database

Year: 2026

Type: article

Abstract: AIM: To describe the structure and content of the population-based KOKO database and to report demographics and quality of care, assessed by nursing-sensitive indicators, in patients with major lower extremity amputation from 2019 to 2022. DESIGN: A cross-sectional study. METHODS: The Kolding KOhort (KOKO) database was established in 2019 to register patients undergoing initial major lower extremity amputation and includes data on quality indicators and prognostic variables. Quality of nursing care was assessed using indicators related to the musculoskeletal system, skin integrity, pain, nutrition, and elimination. Moreover, data on postoperative complications, 30-day readmission and mortality were collected. All data were prospectively extracted from medical records. RESULTS: The cohort comprised 225 patients (62% men; median age 72 years); 54% lived alone. Trans-femoral amputations accounted for 75% of procedures. Pressure ulcer screening was performed in 88%, and 55% received air mattress support. Weight was recorded in 85% at admission, 46% post-amputation, and 44% at discharge. Across postoperative day 1-3, 50-53% of patients were mobilized to a chair. Sufficient stump healing was observed in 50% by day 5 and 57% at discharge. Nearly half reported "no to mild pain" at two time points. Nutritional targets for energy and protein were calculated in 47% and 45% of patients, respectively. Infections (36%) and constipation (28%) were common complications; in-hospital mortality was 7%. CONCLUSION: This study provides the first systematic overview of quality of care among patients undergoing major lower extremity amputation using nursing-sensitive indicators. While strengths were identified, gaps remain in pain management, wound care, and nutrition.

Source: International Journal of Orthopaedic and Trauma Nursing

DOI: 10.1016/j.ijotn.2026.101296

Authors: Charlotte Abrahamsen, Ane Simony, Dorte Dall-Hansen, Inge Hansen Bruun, Pia Kjær Kristensen

Institutions: University of Southern Denmark, Kolding Hospital, Aarhus University, Aarhus University Hospital

Language: English

Topic: Diabetic Foot Ulcer Assessment and Management

Subfield: Endocrinology, Diabetes and Metabolism

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,160