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Citation
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Kayssi A, Dilkas S, Dance DL, De Mestral C, Forbes TL, Roche-Nagle G. PM R 2016; 9(5): 494-501. |
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Affiliation
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Division of Vascular Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada. Electronic address: graham.roche-nagle@uhn.ca. |
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Abstract
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BACKGROUND: The heterogeneity of medical complications that lead to amputation has resulted in a diverse patient population with differing rehabilitation needs. However, the rehabilitation trends for patients with lower-extremity amputations across Canada have not been previously studied.
OBJECTIVE: To describe trends in rehabilitation after lower-extremity amputations and the factors affecting rehabilitation length of stay in Canada.
DESIGN: Retrospective cohort analysis. SETTING: Canadian inpatient rehabilitation facilities that received lower-extremity persons with amputations discharged from academic or community hospitals. PARTICIPANTS: Patients underwent lower-extremity amputations between 2006 and 2009 for non-traumatic indications and were then discharged to a rehabilitation facility. Patients were identified from the Canadian Institute for Health Information's Discharge Abstract Database that includes hospital admissions across Canada except Quebec. INTERVENTIONS: Inpatient rehabilitation after lower-extremity amputations. MAIN OUTCOME MEASURES: Length of stay, discharge destination, change in total and motor function scores.
RESULTS: The analysis included 5342 lower-extremity persons with amputations, 1904 of whom were transferred to a rehabilitation facility (36%). Patients most-commonly underwent single below-knee (74%) and above-knee (17%) amputations. The duration of rehabilitation varied by whether the amputation was performed by a vascular (median= 36 days), orthopedic (median= 38 days), or general surgeon (median= 35 days). The overall median length of stay was 36 days. Most patients (72%) were subsequently discharged home and 9% were readmitted to hospital. Predictors of longer rehabilitation included amputation by an orthopedic surgeon (Beta=5.0, p=<.01), older age (Beta=0.2, p=<.01), and a history of ischemic heart disease (Beta=3.8, p=.03) or congestive heart failure (Beta=5, p=.04). Patients who spent <7 days in hospital were significantly more likely to have a shorter rehabilitation stay (Beta=-4, p=.03). Advanced patient age was the only predictor for hospital readmission (OR=1.03, p=<.01).
CONCLUSIONS: Rehabilitation length of stay in Canada after lower-extremity amputation varies by the type of surgeon performing the amputation. Advanced age, undergoing surgery in the province of Manitoba, and having a history of ischemic heart disease or congestive heart failure predict a longer rehabilitation stay. A shorter perioperative hospitalization period (< 7 days) predicts a shorter rehabilitation duration. Future studies are needed to explore these issues and to optimize the delivery of rehabilitation services to Canadians following lower extremity amputation.
Copyright © 2016 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
Language: en |