A team of researchers in Texas characterized differences between people who were referred to prosthetists compared to those that were not, and identified factors associated with prosthetic referral and survival. The analysis found that being referred for prosthetic fitting was associated with improved survival not explained by patient characteristics and comorbidities. However, the study concluded, further research is needed to determine whether the factors associated with non-referral are due to patient characteristics that make them clinically unsuitable for prosthetic fitting or if they are symptoms of bias or of patients’access to care.
The retrospective analysis included all patients (293) who underwent lower-limb amputations by surgeons in the researchers’ practice from January 1, 2010, to June 30, 2017. Age, sex, race, body mass index (BMI), diabetes, hypertension, hyperlipidemia, end stage renal disease, prior coronary artery bypass graft surgery, congestive heart failure, tobacco use, American Society of Anesthesiologists (ASA) score, previous arterial procedure, chronic obstructive pulmonary disease, statin use, postoperative ambulatory status, level of amputation, stump revision, and referral for prosthesis were collected.
The patients’ mean age was 66 years and mean BMI was 27kg/m2. Most patients were male (69 percent), white (53 percent), with diabetes (65.4 percent) and hypertension (77.5 percent), and underwent a transtibial amputation (BKA) (73 percent). Prosthetic referral occurred in 123 of the patients (42 percent).
Overall five-year survival was 61.7 percent. For those with a transfemoral amputations, five-year survival was 53.8 percent.
Being more than 70 years of age, female, having diabetes, an ASA score of 4 or 5, and current tobacco use were associated with no referral for prosthetic fitting.
Patients with BMI of 25-30, a previous arterial procedure, a transtibial amputation, and history of residual limb revision were more likely to be referred for a prosthesis.
Factors associated with decreased survival were increasing age, higher ASA class, Black race, and BMI; prosthetics referral was seen to be protective.
The study, “Sex, Age, and Other Barriers for Prosthetics Referral Following Amputation and the Impact on Survival,” was published in the Journal of Vascular Surgery.