Long-term risk prediction after major lower limb amputation: 1-year results of the PERCEIVE study
Authors: Gwilym Brenig Llwyd , Pallmann Philip , Waldron Cherry-Ann , Thomas-Jones Emma , Milosevic Sarah , Brookes-Howell Lucy , Harris Debbie , Massey Ian , Burton Jo , Stewart Phillippa , Samuel Katie , Jones Sian , Cox David , Clothier Annie , Prout Hayley , Edwards Adrian , Twine Christopher P , Bosanquet David Charles ,   Vascular and Endovascular Research Network (VERN) and the PERCEIVE study group, Singh Aminder , Saratzis Athanasios , Gwilym Brenig Llwyd , Bosanquet David Charles , Dovell George , Ambler Graeme Keith , Shalhoub Joseph , Hitchman Louise , Machin Matthew , Dattani Nikesh , Birmpili Panagiota , Forsythe Rachael , Blair Robert , Benson Ruth , Preece Ryan , Nandhra Sandip , Onida Sarah , Campbell Amy , Celnik Anna , Renwick Bryce , Moore Jolene , Duncan Karen , Gannon Martin , Duguid Mary , Forget Patrice , Kamal Dhafer , Tolba Mahmoud , Maresch Martin , Hatem Mohamed , Kabis Mohamed , Shalan Ahmed , Travers Hannah , Juszczak Maciej , Elsabbagh Mohammed , Dattani Nikesh , Pereira-Neves António , Rocha-Neves João , Teixeira José , Lim Eric , Hamdulay Khaleel , Lyons Oliver , Azer Ashraf , Francis Chris T , Elsayed Khalid , Makar Ragai , Zaki Shady , Ghatwary-Tantawy Tamer , Mittapalli Devender , Barakat Hashem , Taylor Jessica , Melvin Ross , Veal Samantha , Pachi Anna , Skotsimara Antonia , Maltezos Chrisostomos , Anastasiadou Christiana , Baili Efstratia , Kastrisios George , Maltezos Konstantinos , Saratzis Athanasios , Vijaynagar Badri , Montague-Johnstone Elizabeth , Bright Euan , Stewart Kirsty , Velineni Rahul , Lau Simon , King Will , Papadimitriou Christina , Karkos Christos , Mitka Maria , Chan Emily , Smith George , Vijay Aditya , Agbeko Anita Eseenam , Amoako Joachim , Shalhoub Joseph , Machin Matthew , Antoniou Afroditi , Roditis Konstantinos , Bessias Nikolaos , Tsiantoula Paraskevi , Papas Theofanis , Papaioannou Vasileios , Goodchild Fiona , Dovell George , Dawkins Claire , Rammell James , Nandhra Sandip , Mingoli Andrea , Brachini Gioia , Sapienza Paolo , Lapolla Pierfrancesco , Meldrum Alan , Hussey Keith , Dearie Lara , Nair Manoj , Duncan Andrew , Webb Bryony , Klimach Stefan , Guest Francesca , Hardy Tom , Clothier Annie , Hopkins Luke , Contractor Ummul , Pang Dominic , Tan Li En , Hallatt Meghan , McBride Olivia , Forsythe Rachael , Thurston Ben , Wong Jacqueline , Altaf Nishath , Ash Oliver , Grewal Amandeep , Popplewell Matthew , Jones Steven , Wardle Bethany , Twine Christopher , Heigberg-Gibbons Francesca , Ambler Graeme , Lam Kit , Condie Natalie , Musajee Mustafa , Saha Prakash , Patel Sanjay , Black Stephen , Hayes Thomas , Chawla Ankur , Feghali Anthony , Choudhry Asad , Hammond Eric , Costanza Michael , Shaw Palma , Encalada Ronald Zerna , Surowiec Scott , Cadwallader Craig , Clayton Philipa , Benson Ruth , Herzeele Isabelle Van , Vermeir Lina , Geenens Mia , Moreels Nathalie , Geers Sybille , Jawien Arkadiusz , Arentewicz Tomasz , Tavlas Emmanouil , Kontopodis Nikolaos , Lioudaki Stella , Nyktari Vasiliki , Ibrahim Abdulhakin , Oberhuber Alexander , Neu Jana , Nierhoff Teresa , Moulakakis Konstantinos , Nikolakopoulos Konstantinos , Papadoulas Spyros , Kakkos Stavros , D’Oria Mario , Lepidi Sandro , Lowry Danielle , Kent Frances , Ooi Setthasorn , Patterson Benjamin , Rodriguez Daniel Urriza , Williams Gareth F , Elrefaey Ghadeer Hesham , Enemosah Ibrahim , Gaba Kamran A , Williams Simon , Suthers Elizabeth , Khashram Manar , Hart Odette , Gormley Sinead , French Stephen , Hamid Hytham K S 
Published: January 2024

Abstract

Background
Decision-making when considering major lower limb amputation is complex and requires individualized outcome estimation. It is unknown how accurate healthcare professionals or relevant outcome prediction tools are at predicting outcomes at 1-year after major lower limb amputation.

Methods
An international, multicentre prospective observational study evaluating healthcare professional accuracy in predicting outcomes 1 year after major lower limb amputation and evaluation of relevant outcome prediction tools identified in a systematic search of the literature was undertaken. Observed outcomes at 1 year were compared with: healthcare professionals’ preoperative predictions of death (surgeons and anaesthetists), major lower limb amputation revision (surgeons) and ambulation (surgeons, specialist physiotherapists and vascular nurse practitioners); and probabilities calculated from relevant outcome prediction tools.

Results
A total of 537 patients and 2244 healthcare professional predictions of outcomes were included. Surgeons and anaesthetists had acceptable discrimination (C-statistic = 0.715), calibration and overall performance (Brier score = 0.200) when predicting 1-year death, but performed worse when predicting major lower limb amputation revision and ambulation (C-statistics = 0.627 and 0.662 respectively). Healthcare professionals overestimated the death and major lower limb amputation revision risks. Consultants outperformed trainees, especially when predicting ambulation. Allied healthcare professionals marginally outperformed surgeons in predicting ambulation. Two outcome prediction tools (C-statistics = 0.755 and 0.717, Brier scores = 0.158 and 0.178) outperformed healthcare professionals’ discrimination, calibration and overall performance in predicting death. Two outcome prediction tools for ambulation (C-statistics = 0.688 and 0.667) marginally outperformed healthcare professionals.

Conclusion
There is uncertainty in predicting 1-year outcomes following major lower limb amputation. Different professional groups performed comparably in this study. Two outcome prediction tools for death and two for ambulation outperformed healthcare professionals and may support shared decision-making.