Survival analysis in amputees based on physical independence grade achievement.

Published

Journal Article

BACKGROUND:Survival implications of achieving different grades of physical independence after lower extremity amputation are unknown. OBJECTIVES:To identify thresholds of physical independence achievement associated with improved 6-month survival and to identify and compare other risk factors after removing the influence of the grade achieved. DESIGN:Data were combined from 8 administrative databases. Grade was measured on the basis of 13 individual self-care and mobility activities measured at inpatient rehabilitation discharge. SETTING:Ninety-nine US Department of Veterans Affairs Medical Centers. PATIENTS:Retrospective longitudinal cohort study of 2616 veterans who underwent lower extremity amputation and subsequent inpatient rehabilitation between October 1, 2002, and September 30, 2004. MAIN OUTCOME MEASURE:Cumulative 6-month survival after rehabilitation discharge. RESULTS:The 6-month survival rate (95% confidence interval [CI]) for those at grade 1 (total assistance) was 73.5% (70.5%-76.2%). The achievement of grade 2 (maximal assistance) led to the largest incremental improvement in prognosis with survival increasing to 91.1% (95% CI, 85.6%-94.5%). In amputees who remained at grade 1, the 30-day hazards ratio for survival compared with grade 6 (independent) was 43.9 (95% CI, 10.8-278.2), sharply decreasing with time. Whereas metastatic cancer and hemodialysis remained significantly associated with reduced survival (both P < or = .001), anatomical amputation level was not significant when rehabilitation discharge grade and other diagnostic conditions were considered. CONCLUSIONS:Even a small improvement to grade 2 in the most severely impaired amputees resulted in better 6-month survival. Health care systems must plan appropriate interdisciplinary treatment strategies for both medical and functional issues after amputation.

Full Text

Duke Authors

Cited Authors

  • Stineman, MG; Kurichi, JE; Kwong, PL; Maislin, G; Reker, DM; Vogel, WB; Prvu-Bettger, JA; Bidelspach, DE; Bates, BE

Published Date

  • June 2009

Published In

Volume / Issue

  • 144 / 6

Start / End Page

  • 543 - 552

PubMed ID

  • 19528388

Pubmed Central ID

  • 19528388

Electronic International Standard Serial Number (EISSN)

  • 1538-3644

International Standard Serial Number (ISSN)

  • 0004-0010

Digital Object Identifier (DOI)

  • 10.1001/archsurg.2009.37

Language

  • eng