Discharge destination after dysvascular lower-limb amputations.
OBJECTIVE
To examine postacute care rehabilitation services use after dysvascular amputation.


METHODS
State-maintained hospital discharge data from the Maryland Health Services Cost Review Commission were analyzed.


METHODS
Maryland statewide hospital discharge database.


METHODS
Persons discharged from nonfederal acute care hospitals from 1986 to 1997 with a procedure code for lower-limb amputation (ICD-9-CM code 84.12-.19), excluding toe amputations. Those persons with amputations due to trauma, bone malignancy, or congenital anomalies were excluded.


METHODS
Not applicable.


METHODS
Postacute care service utilization.


RESULTS
There were 16,759 discharges with an amputation procedure over this period. The average age was 69.3+/-14.3 years, and 51.9% were men. Black persons comprised 42.4% of the sample. Diabetes was present in 42.0%, and peripheral vascular disease was noted for 66.1% of amputees. Amputations were at the foot (19.4%), transtibial (38.1%), and transfemoral (42.4%) levels. The largest proportion (40.6%) of patients was discharged directly home after acute care, 37.4% went to a nursing home, 9.2% went home with home care, and 9.6% were discharged to an inpatient rehabilitation unit. From 1986 to 1997, there were downward trends in the rate of discharges directly home and corresponding upward trends in nursing home and inpatient rehabilitation dispositions.


CONCLUSIONS
Inpatient rehabilitation use is infrequent after dysvascular amputation. Prospective studies are necessary to examine outcomes for persons receiving rehabilitation services in different care settings to define the optimal rehabilitation venue for functional restoration.
Dillingham
Timothy R
TR
Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, 53226, USA. tdilling@mcw.edu
Pezzin
Liliana E
LE
Mackenzie
Ellen J
EJ
D000368:Aged; D000671:Amputation, Surgical / Q000534:rehabilitation*; D001186:Artificial Limbs; D005260:Female; D006801:Humans; D007348:Insurance, Health; D007866:Leg; D008297:Male; D008396:Maryland; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D016491:Peripheral Vascular Diseases / Q000601:surgery*; D012047:Rehabilitation Centers