A study examining the effects of the prescription and receipt of prosthetic limbs on three-year mortality found that veterans who had received a prescription for a lower-limb prosthesis within one year of amputation were less likely to die within three years of the amputation. Because of their findings, the authors recommend prioritizing patients’ return to see a prosthetic team because intensive rehabilitation follow-up after hospital discharge could increase the prevalence of prosthetic limb users.
The researchers, using eight Veterans Health Administration (VHA) administrative databases, conducted a retrospective observational study that included 4,578 veterans hospitalized for lower-limb amputations and discharged in fiscal years 2003 and 2004. The outcome was defined as the “time to all-cause mortality” from the surgical date of the amputation to the three-year anniversary of the amputation. Covariates included patient-level characteristics (age (≤65, 66 to 80, and ≥81), gender, marital status, living location before hospitalization (extended care versus non-U.S. Department of Veterans Affairs hospital or home), and rural or urban patient residential setting), treatment-level characteristics (hospital events and diagnostic tests), and facility-level characteristics (rural or urban hospital geographic setting, geographic regions, and hospital size).
Of those veterans included, 1,300 (28.4 percent) received a prescription for a prosthetic limb within one year after the surgical amputation and 2,086 (45.6 percent) died within three years of the surgical anniversary. Among those who received a prescription for a prosthetic limb within one year, only 328 (25.2 percent) died within three years of the surgical anniversary. Even after controlling for other factors known to be associated with mortality, such as age, amputation level, and numerous comorbidities, early receipt of a prescription for a prosthetic limb was a strong factor associated with lower mortality.
The researchers noted that the earlier the prescription for a prosthetic limb was received, the lower the hazards of mortality, but that patients with wound infections or slow healing surgical sites, severe cardiovascular disease, local or systemic infections, or other complicating factors such as nonhealing wounds on their sound limb may see significant delays in the prosthetic fitting process. Such patients may be more medically compromised and have a higher mortality rate in general. Conversely, the early prosthetic prescription may simply be a marker for good health, and healthier people generally live longer. The researchers caution, however, that there may be other factors influencing the receipt of a prosthetic prescription that are also related to mortality that they were not able to identify, obtain, or differentiate in the data. Consequently, the association between receipt of a prosthetic limb and lower mortality should not be interpreted as causal.
The study was published in Volume 52 Number 4, 2015, of the Journal of Rehabilitation Research & Development (JRRD).