Factors associated with prolonged post-operative acute care length of stay in limb amputation patients in Saskatchewan, Canada

Abstract

Background The effect of predisposing factors on post-operative acute care length of stay (POALOS) after lower extremity amputation (LEA) has been sparsely studied with reports largely focused on major (through/proximal to the ankle) LEA specifically due to diabetes mellitus (DM). Although valuable, the narrow focus disregards the impact of other causes and minor levels (distal to the ankle) of LEA. To address this gap, this study aimed to identify predisposing factors associated with prolonged POALOS after index LEA stratified by amputation level in Saskatchewan. Methods The study used Saskatchewan’s provincial linked administrative health data and demographic factors between 2006 and 2019. Amputation levels, identified as major or minor, were derived from the amputation procedure codes. POALOS was calculated by subtracting patients’ intervention date from discharge date, recorded in days, and categorized as short (< 7 days) or prolonged (> 7 days). Multivariable logistic regression was performed to identify predictors associated with prolonged POALOS. Results Of the 3123 LEA cases 1421 (45.5%) had prolonged POALOS. The median POALOS for the entire cohort was 7 days (IQR 3 to 16 days); 5 days (IQR 1 to 10 days) for minor LEA and 11 days (IQR 5 to 23 days) for major LEA. Predictors of prolonged POALOS after minor LEA were diabetes (AOR = 2.47, 95% CI: 1.87–3.27) and general surgeon (AOR = 1.52, 95% CI: 1.21–1.91). Minor LEA performed by orthopedic surgeons were half (AOR = 0.49, 95% CI: 0.35–0.70) as likely to experience prolonged POALOS. Predictors of prolonged POALOS after major LEA were diabetes (AOR = 1.34, 95% CI: 1.04–1.71), general surgeon (AOR = 1.91, 95% CI: 1.45–2.49), urban residence (AOR = 1.58, 95% CI: 1.25–1.99), Resident Indian (RI) status (AOR = 1.57, 95% CI: 1.15–2.15), and age with the likelihood of prolonged POALOS after LEA attenuating with increasing age: 35–54 years (AOR = 2.73, 95% CI: 1.56–4.76); 55–69 years (AOR = 2.65, 95% CI: 1.54–4.58); and 70+ years (AOR = 1.81, 95% CI: 1.05–3.11). Conclusion This study identified only diabetes and surgical specialty predicted prolonged POALOS after both major and minor LEA in Saskatchewan while residence, RI status, and age were predictors of POALOS after major LEA. These findings shed light on the need for further research to identify confounding factors. It is not clear if general surgeons care for more unplanned, emergent cases with poor entry-level health while specialty surgeons perform more scheduled procedures.

Defining Prolonged Length of Stay (PLOS) Following Elective Laparoscopic Cholecystectomy and Derivation of a Preoperative Risk Score to Inform Resource Utilization, Risk Stratification, and Patient Consent

“…[6][7][8][9][10][11] Preoperative risk-scoring for a postoperative adverse outcome is particularly useful. [12][13][14][15] One advantage is that preoperative scoring will inform the consent process. Patients should be given a likelihood of PLOS and the associated operation-related morbidity based on their preoperative risk.…”

“…Preoperative risk-scoring for a postoperative adverse outcome is particularly useful 12–15. One advantage is that preoperative scoring will inform the consent process.…”

Epidemiological Insights into Diabetic Foot Amputation and its Correlates: A Provincial Study

“… 31 , 33 - 35 According to our findings, length of stay was prolonged in comparison to other studies. 36 HbA1c was also above the recommended levels in most subjects. According to most guidelines and available evidence, HbA1c plays a pivotal role in diabetic foot complications.…”

Discharge Disposition After Limb Amputation in a Publicly Funded Health Care System

“…Due to data limitations, this study did not consider race, level of education, or discharge education, each of which has been identified as a significant factor in determining DD or readiness to discharge in patients after surgical intervention in other jurisdictions. 44 , 45 The collective agreement between the researchers and the data trustees precluded the reporting of small numbers, especially in subgroups, to ensure confidentiality, 46 hence limiting the study only to include 5 DD groups. Patients discharged to other dispositions and reported in the database as “left against medical advice with or without sign-out,” “detained by social services,” “addiction treatment center,” “palliative care facility/hospice,” and “cadaveric donor admitted for organ/tissue retrieval” were excluded.…”