Routing through the health care system and level of functioning of lower limb amputees.
OBJECTIVE
To describe the routing through the health care system and the level of functioning of a consecutive series of lower limb amputees at a general Dutch hospital.


METHODS
A descriptive cohort study (medical records examination) with a follow-up interval of 11.7 months. All 124 major lower limb amputations (ankle to hip) between 1 July 1989 and 31 December 1992 are included in the study: 123 patients, average age 73.8 years, 96% vascular disease. Amputation levels are 55.3% transfemoral, 12.2% knee disarticulation and 32.5% transtibial. At follow-up two patients are missing.


RESULTS
Before admission to hospital 75.6% of patients are able to walk and 79.9% live independently. Discharge destinations from hospital are 22.5% home, 42.3% inpatient rehabilitation and 32.4% nursing home. At follow-up, 59% of surviving patients have a prosthesis, 47.7% are able to walk and 70.5% live independently. Mortality after one year is 28.5%. Poor preoperative walkers seem to die more often within the first year and have less chance of being fitted with a prosthesis. Poor walkers, older than 75, with diabetes mellitus and a transfemoral amputation seem to stay more often in a nursing home after one year.


CONCLUSIONS
Although the results are largely comparable with other studies, there appear to be differences in age, amputation level and course and duration of treatment. The predicting factors found here may help the rehabilitation specialist in advising on the best moment and level of amputation and course of treatment.
Uiterwijk
A E
AE
Rehabilitation Centre Delft, The Netherlands.
Remerie
S C
SC
Rol
M
M
Sier
J C
JC
Stam
H J
HJ
Terburg
M
M
D000203:Activities of Daily Living; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000458:organization & administration; D000671:Amputation, Surgical / Q000191:economics / Q000401:mortality / Q000534:rehabilitation*; D001071:Appointments and Schedules; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D007866:Leg; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009735:Nursing Homes; D005791:Patient Care / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000191:economics / Q000534:rehabilitation; D012047:Rehabilitation Centers / Q000458:organization & administration*; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate