Survival analysis in amputees based on physical independence grade achievement.
BACKGROUND
Survival implications of achieving different grades of physical independence after lower extremity amputation are unknown.


OBJECTIVE
To identify thresholds of physical independence achievement associated with improved 6-month survival and to identify and compare other risk factors after removing the influence of the grade achieved.


METHODS
Data were combined from 8 administrative databases. Grade was measured on the basis of 13 individual self-care and mobility activities measured at inpatient rehabilitation discharge.


METHODS
Ninety-nine US Department of Veterans Affairs Medical Centers.


METHODS
Retrospective longitudinal cohort study of 2616 veterans who underwent lower extremity amputation and subsequent inpatient rehabilitation between October 1, 2002, and September 30, 2004.


METHODS
Cumulative 6-month survival after rehabilitation discharge.


RESULTS
The 6-month survival rate (95% confidence interval [CI]) for those at grade 1 (total assistance) was 73.5% (70.5%-76.2%). The achievement of grade 2 (maximal assistance) led to the largest incremental improvement in prognosis with survival increasing to 91.1% (95% CI, 85.6%-94.5%). In amputees who remained at grade 1, the 30-day hazards ratio for survival compared with grade 6 (independent) was 43.9 (95% CI, 10.8-278.2), sharply decreasing with time. Whereas metastatic cancer and hemodialysis remained significantly associated with reduced survival (both P < or = .001), anatomical amputation level was not significant when rehabilitation discharge grade and other diagnostic conditions were considered.


CONCLUSIONS
Even a small improvement to grade 2 in the most severely impaired amputees resulted in better 6-month survival. Health care systems must plan appropriate interdisciplinary treatment strategies for both medical and functional issues after amputation.
Stineman
Margaret G
MG
Department of Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.
Kurichi
Jibby E
JE
Kwong
Pui L
PL
Maislin
Greg
G
Reker
Dean M
DM
Vogel
W Bruce
WB
Prvu-Bettger
Janet A
JA
Bidelspach
Douglas E
DE
Bates
Barbara E
BE
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000534:rehabilitation*; D000674:Amputees / Q000534:rehabilitation*; D004185:Disability Evaluation; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008137:Longitudinal Studies; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D012648:Self Care; D016019:Survival Analysis; D014728:Veterans