Predictors for institutionalization and prosthetic ambulation after major lower extremity amputation during an eight-year follow-up.
OBJECTIVE
Major lower extremity amputation (LEA) leads to great loss in mobility, exposing old people to the risk of losing their independent living status. This study applies predictors for institutionalization and considers prosthesis use by major lower leg amputees with peripheral arterial disease (PAD).


METHODS
119 PAD patients admitted from home (mean age 73.6, SD 11.5 years, 48% men) underwent their first major LEA, 1998- 2002, and survived at least one month after the operation. Logistic regression analysis was run to clarify institutionalization predictors. Prosthesis use and ambulatory capacity were recorded during the follow-up.


RESULTS
Older age, living alone, and unilateral above-knee amputation (AKA) or bilateral amputation predicted institutionalization. Of prosthesis users, 69% (27/39) were younger than 75 and 44% (17/39) were able to walk both in- and outdoors. Reasons for not receiving a prosthesis after amputation were: 1) short expected survival; 2) old age, combined with unilateral AKA or bilateral amputation; 3) unilateral AKA or bilateral amputation and a comorbid condition such as hemiparesis, paraplegia, uremia, dementia, or alcohol misuse. After one year, 72% (36/50) of amputees who were able to return home and 9% (3/32) of amputees in institutional care used a prosthesis.


CONCLUSIONS
The majority of amputated patients cannot return home after their first LEA. Comorbid conditions particularly influencing functional capacity also hinder ambulation with a prosthesis.
Remes
Leena
L
Institute of Clinical Medicine, Department of Public Health, University of Turku, FI-20014 Turku, Finland. leena.remes@utu.fi
Isoaho
Raimo
R
Vahlberg
Tero
T
Viitanen
Matti
M
Rautava
Päivi
P
D017677:Age Distribution; D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D001186:Artificial Limbs / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data*; D008297:Male; D010351:Patient Discharge; D016491:Peripheral Vascular Diseases / Q000453:epidemiology* / Q000601:surgery*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012727:Sex Characteristics; D017678:Sex Distribution; D016138:Walking / Q000706:statistics & numerical data*