Prosthetic fitting, use, and satisfaction following lower-limb amputation: A prospective study

Abstract

Abstract-This study's objective was to determine how treatment-, environmental-, and facility-level characteristics contribute to postdischarge mortality prediction. The study included 4,153 Veterans who underwent lower-limb amputation in Department of Veterans Affairs facilities during fiscal years 2003 and 2004. Veterans were followed 1 yr postamputation. A Cox regression identified characteristics associated with mortality risk after hospital discharge following amputation. Older age, higher amputation level, and more comorbidities increased mortality likelihood. Patients who had inpatient procedures for pulmonary and renal problems had higher hazards of postdischarge death than those who did not (hazard ratio [HR] = 2.10, 95% confidence interval [CI] = 1.16-3.77, and HR = 2.22, 95% CI = 1.80-2.74, respectively). Patients who had central nervous system procedures had higher hazards of death early postdischarge (HR = 2.23, 95% CI = 1.60-3.11) at 0 d, but this association became insignificant by 180 d. Patients in a surgical intensive care unit (ICU), medical ICU, or medical bed section at the time of discharge were more likely to die than patients on a surgical bed section. Patients hospitalized in the Midwest were less likely to die early after discharge than patients in the Mountain Pacific region, but this regional effect became insignificant by 90 d. Adding treatment-, environmental-, and facility-level characteristics contributed additional information to a mortality risk model.

Predicting prosthetic prescription after major lower-limb amputation

“…Data from several retrospective studies and several cohort studies in the United States [9][10][11][12][13][14] and abroad [15][16][17][18][19][20][21][22] show that the rates of prosthetic fitting vary by amputation level, with 1 yr prescription rates ranging from 49 to 93 percent for people with transtibial (TT) amputation, 14 to 57 percent for transfemoral (TF) amputation, 38 to 67 percent for knee disarticulation, and 38 to 100 percent for below-ankle amputation. However, these studies vary in their sampling frame and inclusion and exclusion criteria, and it is not possible to generalize findings to all persons who underwent major limb amputation in the United States or in the VA system.…”

“…Only a few studies report rates of prosthetic prescription within the VA [8,[10][11][12]23]. Webster et al reported the highest rates of prosthetic prescription in any study for patients in a prospective cohort that included 87 persons from a single VA medical center with diabetes or peripheral vascular disease who were ambulatory prior to amputation (93% TT, 57% TF) [10].…”

“…Webster et al reported the highest rates of prosthetic prescription in any study for patients in a prospective cohort that included 87 persons from a single VA medical center with diabetes or peripheral vascular disease who were ambulatory prior to amputation (93% TT, 57% TF) [10]. Nehler et al reported that in a retrospective cohort study of 154 persons with major lower-limb amputation completing rehabilitation at the University of Colorado Health Sciences Center and the Denver VA Medical Center, 43 percent with TT amputation and 10 percent with TF amputation were fit with a prosthesis within 10.3 mo and 52 percent with TT amputation and 19 percent with TF amputation were fit within 17.5 mo [11].…”

The Scope of Non-Trauma Lower Limb Amputations at the Komfo Anokye Teaching Hospital, Kumasi-Ghana

“…Most patients are apprehensive about amputation because of the lack of proper rehabilitation facility and difficulty in accessing prosthesis, a fact confirmed in another study on amputation [10]. Where these facilities are available the psychological burden of being an amputee is minimized [6].…”

“…Patients therefore have other systemic conditions which require additional expensive investigations, resulting in extra economic burden on healthcare cost [6]. It is therefore evident that the socioeconomic impact of these amputations on the individual, their families and the health care system is enormous.…”