Article

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 studied previously. 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 persons with
lower extremity amputations discharged from academic or community hospitals.
PARTICIPANTS: Patients underwent lower extremity amputations between 2006 and
2009 for nontraumatic 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, and change in total and motor function scores. RESULTS: The analysis
included 5342 persons who underwent lower extremity 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%)
subsequently were 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 (odds ratio = 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 after lower
extremity amputation. LEVEL OF EVIDENCE: II.
CI - Copyright (c) 2017 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS