Factors Associated With Home Discharge After Rehabilitation Among Male Veterans With Lower Extremity Amputation

Abstract

Objective To determine the patient-, treatment-, and facility-level factors that are associated with home discharge among male veterans with lower extremity amputation who received inpatient rehabilitation after surgery. Design A retrospective observational study. Setting Veterans Affairs Medical Centers. Participants This study included 1480 male veterans. Methods Generalized estimating equation models were used to model the likelihood of home discharge to account for within-facility clustering. We reported odds ratios (ORs) and 95% confidence intervals (95% CIs). Main Outcome Measurement Discharged to home. Results There were a total of 1163 (78.6%) veterans who were discharged home after the surgical hospitalization, compared with other locations. Patients who were married were more likely to be discharged home compared with patients who were not married (OR = 1.51, 95% CI = 1.14–1.99, P < .01). Compared with being transferred from another hospital or extended care, patients who were admitted from home were far more likely to be discharged home (OR = 8.43, 95% CI = 5.48–12.96, P < .0001). Patients with evidence of local significant infection were less likely to be discharged home (OR = 0.57, 95% CI = 0.39–0.83, P < .01), as were patients with evidence of congestive heart failure (OR = 0.62, 95% CI = 0.45–0.85, P < .01) or depression (OR = 0.63, 95% CI = 0.40–0.98, P = .04). Veterans with greater discharge motor Functional Independence Measure scores were more likely to be discharged home (OR = 1.23, 95% CI = 1.16–1.31 per 10-point increase in discharge Functional Independence Measure motor score, P < .0001). Conversely, patients undergoing procedures for ongoing active cardiac pathology were less likely to be discharged home (OR = 0.55, 95% CI = 0.37–0.81, P < .01). Conclusions This study showed a strong association between the sociological factors of marital status and living location before hospitalization and home discharge. The significance of discharge functional status highlights the importance of addressing the expected care burden once patients are discharged home.

Factors influencing home discharge after inpatient rehabilitation of older patients: a systematic review

“…The sample sizes range from 119 to 63,793 participants. With one exception, all studies [ 31 ] included both male and female participants.…”

“…Three studies investigated the association between marital status and discharge disposition. All of these studies revealed that being married is significantly related to home discharge [ 9 , 29 , 31 ]. Three studies indicated a positive association between higher functional status at admission and home discharge [ 10 , 27 , 28 ].…”

Department of Veterans Affairs Amputation System of Care: 5 years of accomplishments and outcomes

“…Because of this, the ASoC has focused primarily on enhancing care excellence in this setting. Many individuals who undergo amputation still require inpatient rehabilitation services, and there is a growing body of evidence supporting the benefits of comprehensive inpatient rehabilitation programs for this population [8][9]. Monitoring these inpatient rehabilitation outcomes is integral to the ASoC.…”

Comprehensive versus consultative rehabilitation services postacute stroke: Outcomes differ

“…The selection of variables was hypothesis-driven based on clinical plausibility and literature review of rehabilitation referral decision-making and the determinants of functional recovery [19][20][21][22][23][24][25][26][27], mortality [27][28][29][30][31][32], and home discharge following hospitalization [33][34][35][36][37][38][39][40]. It is generally recommended that propensity analysis be treated as the main analysis over traditional covariate adjustment analysis [41].…”