Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 6 , Pages 1038-1045, June 2008

Rehabilitation Setting and Associated Mortality and Medical Stability Among Persons With Amputations

  • Timothy R. Dillingham, MD

      Affiliations

    • Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI
    • Zablocki VA Medical Center, Milwaukee, WI.
    • Corresponding Author InformationReprint requests to Timothy R. Dillingham, MD, 18950 Ashford Ln, Brookfield, WI 53045-8100
    • ,
  • Liliana E. Pezzin, PhD

      Affiliations

    • Department of Medicine and Health Policy Institute, Medical College of Wisconsin, Milwaukee, WI

Abstract 

Dillingham TR, Pezzin LE. Rehabilitation setting and associated mortality and medical stability among persons with amputations.

Objective

To estimate the differences in outcomes across postacute care settings—inpatient rehabilitation, skilled nursing facility (SNF), or home—for dysvascular lower-limb amputees.

Design

Medicare claims data for 1996 were used to identify a cohort of elderly persons with major lower-limb dysvascular amputations. One-year outcomes were derived by analyzing claims for this cohort in 1996 and 1997.

Setting

Postacute care after amputation.

Participants

Dysvascular lower-limb elderly amputees (N=2468).

Interventions

Not applicable.

Main Outcome Measures

Mortality, medical stability, reamputations, and prosthetic device acquisition.

Results

The 1-year mortality for the elderly amputees was 41%. Multivariate probit models controlling for patient characteristics indicated that patients discharged to inpatient rehabilitation were significantly (P<.001) more likely to have survived 12 months postamputation (75%) than those discharged to an SNF (63%) or those sent home (51%). Acquisition of a prosthesis was significantly (P<.001) more frequent for persons going to inpatient rehabilitation (73%) compared with SNF (58%) and home (49%) dispositions. The number of nonamputee-related hospital admissions was significantly less for persons sent to a rehabilitation service than for those sent home or to an SNF. Subsequent amputations were significantly (P<.025) less likely for amputees receiving inpatient rehabilitation (18%) than for those sent home (25%).

Conclusions

Receiving inpatient rehabilitation care immediately after acute care was associated with reduced mortality, fewer subsequent amputations, greater acquisition of prosthetic devices, and greater medical stability than for patients who were sent home or to an SNF. Such information is vital for health policy makers, physicians, and insurers.

Key Words: Amputation, Peripheral vascular disease, Rehabilitation, Skilled nursing facilities

 

 Supported by the National Institutes of Health, National Institute of Child Health and Human Development, and the National Center for Medical Rehabilitation Research (grant nos. R29HD36414, R01HD36414).

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

PII: S0003-9993(08)00204-9

doi:10.1016/j.apmr.2007.11.034

Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 6 , Pages 1038-1045, June 2008

Article Tools