Effects of prosthetic limb prescription on 3-year mortality among Veterans with lower-limb amputation

Abstract

Our objective was to determine the relationship between receipt of a prescription for a prosthetic limb and three-year mortality post-surgery among veterans with lower extremity amputation. We conducted a retrospective observational study that included 4,578 veterans hospitalized for lower extremity amputation and discharged in Fiscal Years 2003 and 2004. The outcome was time to all-cause mortality from the amputation surgical date up to the 3-year anniversary of the surgical date. There were 1,300 (28.4%) veterans with lower extremity amputations who received a prescription for a prosthetic limb within a year after the surgical amputation. About 46% (n=2086) died within three-years of the surgical anniversary. Among those who received a prescription for a prosthetic limb, only 25.2% died within 3 years of the surgical anniversary. After adjustment, veterans who received a prescription for a prosthetic limb were less likely to die after the surgery than veterans without a prescription with a hazard ratio of 0.68 (95% CI, 0.60-0.77). Findings demonstrated that veterans with lower extremity amputations who received a prescription for a prosthetic limb within a year after the surgical amputation were less likely to die within three years of the surgical amputation after controlling for patient-, treatment-, and facility-level characteristics.

Patient Experience of Recovery After Major Leg Amputation for Arterial Disease

“…It has implications on quality of life 11,23 and may impact mortality. 24 We found that obtaining and successfully using a prosthetic leg was closely tied to the perception of a successful functional recovery by participants. However, despite all patients having participated in rehabilitation postoperatively, many felt that this was insufficient.…”

Impact of Time to Receipt of Prosthesis on Total Healthcare Costs 12 Months Postamputation

“…The primary finding of financial benefits coinciding with earlier delivery of a prosthesis is in alignment with previous evidence regarding the clinical benefits of early fitting of a prosthesis. 17 , 21 , 23 Proposed clinical practice guidelines have suggested that intervention with a prosthesis early in the rehabilitation process is critical to individual physical health and improved quality care and promotes cost-effective patient management. 24 There is a likelihood of different healing rates among patients post-LLA.…”

“…Limited data would suggest that if a patient does not receive a custom prosthesis within 12 to 18 mos, it is possible for the individual to decline to a health state so poor that they are considered unlikely to benefit from a prosthesis. 8 , 17 About 30% to 60% of adults exclusively use a wheelchair after LLA, which significantly reduces quality of life, independence, and cardiovascular health. 18 However, adults who receive early rehabilitation after a transtibial amputation have improved mobility compared with matched individuals with no rehabilitation services and up to 80% lower hazard of death if they are a prosthesis user.…”

“… 18 However, adults who receive early rehabilitation after a transtibial amputation have improved mobility compared with matched individuals with no rehabilitation services and up to 80% lower hazard of death if they are a prosthesis user. 17 , 19 …”

Ageing, limb-loss and military veterans: a systematic review of the literature

“…Kurichi et al . 2015; Littman et al . 2014), our focus in this systematic review is on the first group whose injuries are ‘service attributable’.…”