Background: Non-traumatic lower limb amputation is a commonly performed surgical procedure and is associated with a high prevalence of psychological morbidity including anxiety and depression. Many risk factors have been identified, including the indication for amputation, perioperative pain and sociodemographic factors. Aim: The aim of this study was to identify whether level of amputation has an impact on this psychological morbidity. Methods: A prospective observational study was conducted in a tertiary hospital including all adult non- traumatic amputations performed during a 6 month period. The Hospital Anxiety and Depression Scale (HADS) was used to score anxiety and depression pre and postoperatively. Results: 50 patients met the inclusion criteria – 23 trans-femoral amputations (AKA) and 27 trans-tibial amputations (BKA). HADS scores for anxiety and depression were high in both groups both pre and post-operatively. A higher level of anxiety was noted in the BKA group, significantly decreasing postoperatively (p < 0.05). No other statistically significant differences were found between the two groups. Conclusion: In non-traumatic amputations, there appears to be a higher rate of pre-operative anxiety in patients undergoing trans-tibial amputation compared with trans-femoral amputees. However, the level of amputation does not appear to have a significant effect on psychological status of patients with high rates of depression and anxiety demonstrated in both groups.

Background: Non-traumatic lower limb amputation is a commonly performed surgical procedure and is associated with a high prevalence of psychological morbidity including anxiety and depression. Many risk factors have been identified, including the indication for amputation, perioperative pain and sociodemographic factors. Aim: The aim of this study was to identify whether level of amputation has an impact on this psychological morbidity. Methods: A prospective observational study was conducted in a tertiary hospital including all adult non- traumatic amputations performed during a 6 month period. The Hospital Anxiety and Depression Scale (HADS) was used to score anxiety and depression pre and postoperatively. Results: 50 patients met the inclusion criteria – 23 trans-femoral amputations (AKA) and 27 trans-tibial amputations (BKA). HADS scores for anxiety and depression were high in both groups both pre and post-operatively. A higher level of anxiety was noted in the BKA group, significantly decreasing postoperatively (p < 0.05). No other statistically significant differences were found between the two groups. Conclusion: In non-traumatic amputations, there appears to be a higher rate of pre-operative anxiety in patients undergoing trans-tibial amputation compared with trans-femoral amputees. However, the level of amputation does not appear to have a significant effect on psychological status of patients with high rates of depression and anxiety demonstrated in both groups.