Patient education level affects functionality and long term mortality after major lower extremity amputation

Corey, Michael R.; Julien, Jamii St.; Miller, Carly; Fisher, Bryan; Cederstrand, Sara L.; Nylander, William; Guzman, Raul J.; Dattilo, Jeffery B.

doi:10.1016/j.amjsurg.2012.07.018

Cited by 17 publications

(11 citation statements)

References 14 publications

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“…Self-rated literacy could not explain these educational disparities. The association that we found between educational level and health is consistent with the findings in other studies [22-26]. An unexpected finding in our study was the relatively high educational level among people from non-British/English background.…”

Section: Discussionsupporting

confidence: 93%

Self-rated literacy level does not explain educational differences in health and disease

et al. 2014

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BackgroundAlthough literacy is increasingly considered to play a role in socioeconomic inequalities in health, its contribution to the explanation of educational differences in health has remained unexplored. The aim of this study was to investigate the contribution of self-rated literacy to educational differences in health.MethodsData was collected from the Healthy Foundation and Lifestyle Segmentation Dataset (n = 4257). Self-rated literacy was estimated by individuals’ self-reported confidence in reading written English. We used logistic regression analyses to assess the association between educational level and health (long term conditions and self-rated health). Self-rated literacy and other potential explanatory variables were separately added to each model. For each added variable we calculated the percentage change in odds ratio to assess the contribution to the explanation of educational differences in health.ResultsPeople with lower educational attainment level were more likely to report a long term condition (OR 2.04, CI 1.80-2.32). These educational differences could mostly be explained by age (OR decreased by 27%) and could only minimally be explained by self-rated literacy, as measured by self-rated reading skills (OR decreased by 1%). Literacy could not explain differences in cardiovascular condition or diabetes, and only minimally contributed to mental health problems and depression (OR decreased by 5%). The odds of rating ones own health more negatively was higher for people with a low educational level compared to those with a higher educational level (OR 1.83, CI 1.59-2.010), self-rated literacy decreased the OR by 7%.ConclusionMeasuring self-rated reading skills does not contribute significantly to the explanation of educational differences in health and disease. Further research should aim for the development of objective generic and specific instruments to measure health literacy skills in the context of health care, disease prevention and health promotion. Such instruments are not only important in the explanation of educational differences in health and disease, but can also be used to identify a group at risk of poorer health through low basic skills, enabling health services and health information to be targeted at those with greater need.

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Section: Discussionsupporting

confidence: 93%

Self-rated literacy level does not explain educational differences in health and disease

et al. 2014

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“…Although we have not collected data in patients who were not offered amputation (because other surgical options were available, or patient refusal or co-morbidity was felt to preclude surgery), it seems likely that a different casemix accounts for some of these differences. Corey and colleagues found that age, number of comorbidities, ASA grade and poor educational attainment (as a surrogate for lower socio-economic status) were associated with a worse five-year outcome after amputation [20]. To improve the outcome of patients undergoing amputation, the VSGBI released a quality improvement framework in November 2010, with the aim of reducing the peri-operative mortality of major lower limb amputation to < 5%.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing short‐ and long‐term mortality after lower limb amputation

et al. 2014

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SummaryMortality after lower limb amputation is high, with UK 30-day mortality rates of 9-17%. We performed a retrospective analysis of factors affecting early and late outcome after lower limb amputation for peripheral vascular disease or diabetic complications at a UK tertiary referral vascular centre between 2003 and 2010. Three hundred and thirty-nine patients (233 male), of median (IQR [range]) age 73 (62-79 [26-92]) years underwent amputation. Thirty-day mortality was 12.4%. On regression modelling, the risk of 30-day mortality was increased in patients of ASA grade ≥ 4 (OR 4.23, 95% CI 2.07-8.63), p < 0.001 and age between 74 and 79 years (OR 3.8, 95% CI 1.10-13.13), p = 0.04 and older than 79 years (OR 4.08, 95% CI 1.25-13.25), p = 0.02. Peri-operative (30-day) mortality for these groups was 23.2%, 13.7% and 18.8%, respectively. Survival and Cox regression analysis demonstrated that long-term mortality was associated with: age 74-79 years (HR 2.15, 95% CI 1.38-3.35), p = 0.001; age > 79 years (HR 2.78, 95% CI 1.82-4.25), p < 0.001; ASA grade ≥ 4 (HR 2.04, 95% CI 1.51-2.75), p < 0.001; out-of-hours operating (HR 1.51, 95% CI 1.08-2.10), p = 0.02; and chronic kidney disease stage 4-5 (1.57, 95% CI 1.07-2.30), p = 0.02. Anaesthetic technique was associated with long-term mortality on survival analysis (p = 0.04), but not when analysed using regression modelling. Mortality after lower limb amputation relates to patient age, ASA, out-of-hours surgery and renal dysfunction. These data support lower limb amputations' being performed during daytime hours and after modification of correctable risk factors.

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“…Corey revealed that persons with lower education level have an increased mortality rate after amputation. 13 That may be as well put on the above statement because those with higher levels of education care for them more and may adopt a preventing style instead of presenting to medical services in late advanced disease stages.…”

Section: Discussionmentioning

confidence: 99%

Demographic and Comorbidity Pattern of Patients with Critical Limb Ischemia

et al. 2017

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Aim: The present study aimed at identifying the pattern of patients with critical limb ischemia (CLI) compared with those with peripheral arterial occlusive disease (PAOD). Materials and methods: A four-year retrospective study was conducted with patients hospitalized in the Second Surgical Clinic at the Emergency County Hospital Cluj-Napoca. The medical charts of patients with PAOD (n=466) and CLI (n=223) were reviewed and data were collected. Results: The study included 689 patients; mean age 67 years for PAOD patients and 65 years for CLI patients. A significantly higher percentage of patients were male in both groups (79.25%, P < 0.0001). Most of the patients in both groups had received at least a secondary education (P < 0.0001). Most of the subjects in both groups were smokers (>71.30%) with no difference between groups (P = 0.566). No significant differences were found between the groups in comorbidities (diabetes, arterial blood hypertension, cardiac ischemia, rhythm disorders, P > 0.05). There were more CLI patients that were overweight than overweight patients with PAOD (P = 0.0004). High serum cholesterol (>200 mg/dL) and triglycerides (>150 mg/dL) levels were found in the CLI group (P < 0.05). Age was identified as a risk factors for amputation (OR = 1.03, 95%Cl [1.01−1.05], P = 0.0012). Conclusions: The profile of a patient with critical limb ischemia and peripheral arterial occlusive disease is a 65-67-year-old male smoker with at least a secondary education. The CLI patient is overweight with pathological serum levels of cholesterol and triglycerides.

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Patient education level affects functionality and long term mortality after major lower extremity amputation

Cited by 17 publications

References 14 publications

Self-rated literacy level does not explain educational differences in health and disease

Self-rated literacy level does not explain educational differences in health and disease

Factors influencing short‐ and long‐term mortality after lower limb amputation

Demographic and Comorbidity Pattern of Patients with Critical Limb Ischemia

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