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Logo for the Journal of Rehab R&D
Volume 43 Number 7, November/December 2006
Pages 917 — 928


Abstract - Risk factors associated with mortality in veteran population following transtibial or transfemoral amputation

Barbara Bates, MD;1-2* Margaret G . Stineman, MD;3-4 Dean M. Reker, PhD, RN;5-6 Jibby E. Kurichi, MPH;3 Pui L. Kwong, MPH3

1Samuel S. Stratton Department of Veterans Affairs (VA) Medical Center (VAMC), Albany, NY; 2Department of Physical Medicine and Rehabilitation, Albany Medical College, Albany, NY; 3Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA; 4VA Center for Health Equity Research and Promotion, Philadelphia, PA; 5Kansas City VAMC, Kansas City, MO; 6The University of Kansas Medical Center, Kansas City, KS
Abstract — This study explored medical conditions associated with mortality among veterans following transfemoral amputation, transtibial amputation, or hip disarticulation. We applied logistic regression models to identify clinical factors associated with mortality postoperatively. The participants included patients with lower-limb amputations (n = 2,375) who were discharged from Veterans Health Administration hospitals between October 1, 2002, and September 30, 2003. Most (98.9%) were male. We measured cumulative in-hospital, 3-month, and 1-year mortality. The results were 180 in-hospital deaths, 368 by 3 months, and 634 by the 1-year postsurgical amputation date. Those who had perioperative systemic sepsis (odds ratio = 4.28, 95% confidence interval = 2.87-6.39) had more than a fourfold increased likelihood of in-hospital mortality. Congestive heart failure, renal failure, and liver disease were significantly associated with mortality at all time periods. Metastatic cancer was associated only at 3 months and 1 year. We concluded that high medical complexity and mortality rates attest to the need for careful medical oversight during the postacute rehabilitation period.
Key words: aging, amputation, artificial limbs, comorbidity, hospital mortality, mortality, regression analysis, rehabilitation, sepsis, veterans.

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