Dec 15

Prolonged Periods of Postoperative Bedrest

Hi All,

A colleague of mine recently took a job at another hospital. She has found that their LL amputees are placed on 5 days bed rest postoperatively. She has not yet viewed the formal protocol though this was handed over to her from the vascular registrar. He cited protection of the stump as the reason for this. Has anyone else experienced such a long period of bed rest as a uniform approach to postop management? Given the population we are seeing for many amputations I would have thought that this would place them at risk of a number of other complications.

Any thoughts?



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  1. Naomi

    Hi All,

    I have found that the 5 days bed rest is the culture at my new workplace also, although no formal protocols are in place. Our amputee patients do not have any rigid dressings fitted until they get out to rehab (just crepe bandages in the acute setting).

    I would be interested in any comments other people have re this.

    Thanks, Naomi

  2. Heather Curtis

    Hi there I don’t have any specific evidence available to hand for amputees….. but one of my colleagues in Alfred Health has been looking at this question recently in ankle fractures here and found that the bed rest group (think they got up day 2 so not quite day 5!) needed more analgesia and stayed in hospital longer….and had no evidence of wound complications or readmission
    Kimmel LA, Edwards ER, Liew SM, Oldmeadow LB, Webb MJ, Holland AE: Rest easy? Is bed rest really necessary after surgical repair of an ankle fracture? Injury; 2012 Jun;43(6):766-71
    PMID: 21962296
    Lara Kimmel also suggested this article
    Allen C, Glasziou P, Del Mar C. Bed rest: a potentially harmful treatment needing more careful evaluation. The Lancet 1999;354(9186):1229–33.
    Which is a meta analysis that showed no improvements found in bed rest…..

    Bit off the amputee topic but might be a starting point!
    I have worked in amputee areas for 20 years or so (though more recently in subacute) and have never come across any protocols for languishing in bed for 5 days!!! Can’t imagine this is helpful to clients holistically either vascular or the non vascular ones. A wheelchair with a stumprest would still keep wound elevated/minimize odema and can be pivoted into with minimal trauma and allow clients mobility. Some of the RRD’s can stop wounds getting pulled around a lot in transfers and movements in bed and from all facets – chest/DVT/general strength /flexibility /pressure areas- (heels & sacrums especially)/mental psycho social health factors/beginning rehab and working to discharge I would have thought getting people up and moving early was all important

  3. lynette wakefield

    Hi All,

    I’ve been working in the amputee field for nearly 30 years and have never experienced a uniform policy of 5 days bed rest post lower limb amputation adn this is even prior to RRDs. Are these surgeons routinuely skin grafting to gain would closure?

    There are times when patients are unwell and are unable to move out of bed but this is not the routine and in most of these cases early mobilisation as medical status allows is asked for. There are other ways of protecting wounds including RRD, ensuring correct dressings and residual limb elevation when sitting out of bed as well as care when askign patients to move so I personally see no reason to support this position. It alos has the potential to create a raft of other problems or exacerbate them.including but not limited to the most obvious deconditioning and respiratroy issues that need not occur Was there a bad outcome with a particular patient or patient after early mobilisation. Often one bad experience can be the reaon behind what appear to be strange practices

    In this day and age when length of stay and presure on bed usuage issues so high I am amazed that this practice has not been challenged. My approach would be to firstly have this protocal confirmed by the head of unit as registras often change and information can become lost or misinterpeted. Also ask how old is the protocal?. If its hasn’t been reviewed for awhile offer to do this. If relatively new and states that bed rest is required rfor 5 days then collect evidence from both the literature and other sites and speak with the head of unit to see if you can negotiate a change in practice using the arguement of equitable if not better outcomes, reduced risk of complications, reduced legnth of stay and pressure on beds. Head of units understand this as they are trying to balance waiting list and theatere list against bed avaiabllity on a daily if not hourly basis.You may only gain a day or two at a time but at least you wil be moving things in the direction you believe to be more appropriate for your patients. For the record well LL amputees are sat out of bed day one post op on this site as a routine, mobilised if possible.

  4. Cathy Howells

    I have come across this complaint from amputee physios before and often it is the case that the wounds are being closed with staples rather than sutures. One registrar introduced this at RPAH over 20 yrs ago. He was smartly assured by the delayed wound healing and stumps falling apart that this was not the optimal form of wound closure. Sutures were reinstated. Mobilising started on day one and compression bandaging on day 3 post -op. Bedrails up at night.

  5. lynette wakefield

    Dear Terry

    In answer to the questions posed the decsion sits with the physiotherapist for all of the mobility tasks and we aim for the following 1.Day one and 2..Day one- most are wheelchair mobile. The physiotherapist will look at all patient factors (including the wound) before shifting the patient out of bed and progressing to mobilising. In reality it is often not the wound that is the issue with our patient group but their genral state of health prior to the amputation.

    3.Initial dressings are usually soft for both TT adn TF as we do not have an onsite prosthetist and not all surgeons will apply a RRD in theatre. The TT are changed to a RR as soon as the prosthetist is available to do this as a preference.

    You could also try reviewing the WA and SA Rehabilitiation plans for amputees which also quote Bacpar and the Final Report to the New Zealand Artificail LImb Board and reference articles about best practice and assigns responsibility for tasks to specific members of the multi- d team. Not surprsingly mobility seems to fall to physiothepay in these. None seem to indicate that sitting out of bed or mobility will damange the wound if done well and the wound is not a risk. from other factors.

    Kind regards

    Lynne Wakefield

    Hope this is of help

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