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Survival analysis in amputees based on physical independence grade achievement.

Publication ,  Journal Article
Stineman, MG; Kurichi, JE; Kwong, PL; Maislin, G; Reker, DM; Vogel, WB; Prvu-Bettger, JA; Bidelspach, DE; Bates, BE
Published in: Arch Surg
June 2009

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.

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Published In

Arch Surg

DOI

EISSN

1538-3644

Publication Date

June 2009

Volume

144

Issue

6

Start / End Page

543 / 551

Location

United States

Related Subject Headings

  • Veterans
  • Survival Analysis
  • Surgery
  • Self Care
  • Risk Factors
  • Retrospective Studies
  • Recovery of Function
  • Middle Aged
  • Male
  • Lower Extremity
 

Citation

APA
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MLA
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Stineman, M. G., Kurichi, J. E., Kwong, P. L., Maislin, G., Reker, D. M., Vogel, W. B., … Bates, B. E. (2009). Survival analysis in amputees based on physical independence grade achievement. Arch Surg, 144(6), 543–551. https://doi.org/10.1001/archsurg.2009.37
Stineman, Margaret G., Jibby E. Kurichi, Pui L. Kwong, Greg Maislin, Dean M. Reker, W Bruce Vogel, Janet A. Prvu-Bettger, Douglas E. Bidelspach, and Barbara E. Bates. “Survival analysis in amputees based on physical independence grade achievement.Arch Surg 144, no. 6 (June 2009): 543–51. https://doi.org/10.1001/archsurg.2009.37.
Stineman MG, Kurichi JE, Kwong PL, Maislin G, Reker DM, Vogel WB, et al. Survival analysis in amputees based on physical independence grade achievement. Arch Surg. 2009 Jun;144(6):543–51.
Stineman, Margaret G., et al. “Survival analysis in amputees based on physical independence grade achievement.Arch Surg, vol. 144, no. 6, June 2009, pp. 543–51. Pubmed, doi:10.1001/archsurg.2009.37.
Stineman MG, Kurichi JE, Kwong PL, Maislin G, Reker DM, Vogel WB, Prvu-Bettger JA, Bidelspach DE, Bates BE. Survival analysis in amputees based on physical independence grade achievement. Arch Surg. 2009 Jun;144(6):543–551.

Published In

Arch Surg

DOI

EISSN

1538-3644

Publication Date

June 2009

Volume

144

Issue

6

Start / End Page

543 / 551

Location

United States

Related Subject Headings

  • Veterans
  • Survival Analysis
  • Surgery
  • Self Care
  • Risk Factors
  • Retrospective Studies
  • Recovery of Function
  • Middle Aged
  • Male
  • Lower Extremity