Comorbidity has no impact on unplanned discharge or functional gains in persons with dysvascular amputation
Raymond Cheng, Sean Smith, Claire Z. Kalpakjian
University of Michigan Medical School, Department of Physical Medicine and Rehabilitation, Ann Arbor, USA. E-mail: firstname.lastname@example.org
Objective: To examine how factors associated with infection, organ failure, poor wound healing, or indices of chronic vascular disease are associated with unplanned transfers and functional gains in a population of dysvascular amputees during inpatient rehabilitation.
Setting: Inpatient rehabilitation unit at an academic medical centre.
Patients: A total of 118 patients with new, dysvascular, lower-extremity, amputation participating in inpatient rehabilitation.
Methods: Logistic regression and indices of change (minimal detectable change; MDC90), standardized response mean and effect size were used to examine the risks of unplanned transfer and functional change.
Main outcome measurements: Rate of unplanned transfers from rehabilitation, and Functional Independence Measure (FIM).
Results: Out of the total of 118 patients 19 had unplanned transfers due to medical complications. Age, creatinine, haemoglobin, white blood cell count, haemodialysis, wound vacuum device use, intravenous antibiotic use, or previous amputations were not independently associated with unplanned transfers, motor FIM change or efficiency. The MDC90 for motor FIM was 17.84, with 21.2% of patients exceeding this value; standardized response mean and effect size were large (1.03 and 1.39, respectively).
Conclusion: This study suggests that the presence of comorbidities in a population of dysvascular amputees participating in inpatient rehabilitation did not increase the risk of unplanned transfers or affect FIM gains.
Patients who undergo a lower extremity amputation due to poor blood flow often have multiple, long-term medical conditions that increase the risk of complications after surgery. They also tend to be in worse physical condition than the average person, even prior to amputation. After an amputation, people often participate in physical rehabilitation in a hospital to improve their strength, and to learn how to get around their homes and communities without a limb. We suspected that chronic medical conditions related to poor blood flow and amputation would make it more difficult for patients to participate in rehabilitation. This study of 118 patients who required lower extremity amputation due to poor blood flow found that, despite multiple medical comorbidities, these patients benefited from in-hospital rehabilitation after their surgeries as much as patients who were in rehabilitation for other reasons.
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