Journal of Rehabilitation Research & Development (JRRD)

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Volume 49 Number 9, 2012
   Pages 1479 — 1492

Abstract — Revisiting risks associated with mortality following initial transtibial or transfemoral amputation

Barbara E. Bates, MD, MBA;1* Dawei Xie, PhD;2 Jibby E. Kurichi, MPH;2 Diane Cowper Ripley, PhD;3 Pui L. Kwong, MPH;2 Margaret G. Stineman, MD2,4

1Albany Stratton Department of Veterans Affairs (VA) Medical Center, Albany, NY; and Department of Physical Medicine and Rehabilitation, Albany Medical College, Albany, NY; 2Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA; 3North Florida/South Georgia Veterans Hospital System, Gainesville, FL; and Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL; 4Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA

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.

Key words: administrative data, amputation, comorbidity, elderly, integrated, lower limb, mortality, outcome assessment, rehabilitation, Veteran.

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