The Effectiveness of Inpatient Rehabilitation in the Acute Postoperative Phase of Care After Transtibial or Transfemoral Amputation: Study of an Integrated Health Care Delivery System
Abstract
Stineman MG, Kwong PL, Kurichi JE, Prvu-Bettger JA, Vogel WB, Maislin G, Bates BE, Reker DM. The effectiveness of inpatient rehabilitation in the acute postoperative phase of care after transtibial or transfemoral amputation: study of an integrated health care delivery system.
Objective
To compare outcomes between lower-extremity amputees who receive and do not receive acute postoperative inpatient rehabilitation within a large integrated health care delivery system.
Design
An observational study using multivariable propensity score risk adjustment to reduce treatment selection bias.
Setting
Data compiled from 9 administrative databases from Veterans Affairs Medical Centers.
Participants
A national cohort of veterans (N=2673) who underwent transtibial or transfemoral amputation between October 1, 2002, and September 30, 2004.
Interventions
Not applicable.
Main Outcome Measures
One-year cumulative survival, home discharge from the hospital, and prosthetic limb procurement within the first postoperative year.
Results
After reducing selection bias, patients who received acute postoperative inpatient rehabilitation compared to those with no evidence of inpatient rehabilitation had an increased likelihood of 1-year survival (odds ratio [OR]=1.51; 95% confidence interval [CI], 1.26–1.80) and home discharge (OR=2.58; 95% CI, 2.17–3.06). Prosthetic limb procurement did not differ significantly between groups.
Conclusions
The receipt of rehabilitation in the acute postoperative inpatient period was associated with a greater likelihood of 1-year survival and home discharge from the hospital. Results support early postoperative inpatient rehabilitation following amputation.
Correspondence to Margaret G. Stineman, MD, 101 Ralston-Penn Center, 3615 Chestnut St, Philadelphia, PA 19104-2676 Reprints are not available from the author.
Supported by the National Center for Medical Rehabilitation Research National Institutes of Health (grant no. RO1-HD042588); and resources and the use of facilities at the Samuel S. Stratton Department of Veterans Affairs Medical Center in Albany, NY, and the Kansas City Department of Veterans Affairs Medical Center in Kansas City, MO.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
ABSTRACT