Rehabilitation Trends After Lower Extremity Amputations in Canada.
BACKGROUND
The heterogeneity of medical complications that lead to amputation has resulted in a diverse patient population with differing rehabilitation needs; however, the rehabilitation trends for patients with lower extremity amputations across Canada have not been studied previously.


OBJECTIVE
To describe trends in rehabilitation after lower extremity amputations and the factors affecting rehabilitation length of stay in Canada.


METHODS
Retrospective cohort analysis.


METHODS
Canadian inpatient rehabilitation facilities that received persons with lower extremity amputations discharged from academic or community hospitals.


METHODS
Patients underwent lower extremity amputations between 2006 and 2009 for nontraumatic indications and were then discharged to a rehabilitation facility. Patients were identified from the Canadian Institute for Health Information's Discharge Abstract Database that includes hospital admissions across Canada except Quebec.


METHODS
Inpatient rehabilitation after lower extremity amputations.


METHODS
Length of stay, discharge destination, and change in total and motor function scores.


RESULTS
The analysis included 5342 persons who underwent lower extremity amputations, 1904 of whom were transferred to a rehabilitation facility (36%). Patients most commonly underwent single below-knee (74%) and above-knee (17%) amputations. The duration of rehabilitation varied by whether the amputation was performed by a vascular (median = 36 days), orthopedic (median = 38 days), or general surgeon (median = 35 days). The overall median length of stay was 36 days. Most patients (72%) subsequently were discharged home and 9% were readmitted to hospital. Predictors of longer rehabilitation included amputation by an orthopedic surgeon (beta = 5.0, P ≤ .01), older age (beta = 0.2, P ≤ .01), and a history of ischemic heart disease (beta = 3.8, P = .03) or congestive heart failure (beta = 5, P = .04). Patients who spent <7 days in hospital were significantly more likely to have a shorter rehabilitation stay (beta = -4, P = .03). Advanced patient age was the only predictor for hospital readmission (odds ratio = 1.03, P ≤ .01).


CONCLUSIONS
Rehabilitation length of stay in Canada after lower extremity amputation varies by the type of surgeon performing the amputation. Advanced age, undergoing surgery in the province of Manitoba, and having a history of ischemic heart disease or congestive heart failure predict a longer rehabilitation stay. A shorter perioperative hospitalization period (<7 days) predicts a shorter rehabilitation duration. Future studies are needed to explore these issues and to optimize the delivery of rehabilitation services to Canadians after lower extremity amputation.


METHODS
II.
Division of Vascular Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada(∗).
Ahmed
A
Kayssi
Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada(†).
Steven
S
Dilkas
Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada(‡).
Derry L
DL
Dance
Division of Vascular Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada(§).
Charles
C
de Mestral
Division of Vascular Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada(¶).
Thomas L
TL
Forbes
Division of Vascular Surgery, University Health Network, University of Toronto, 200 Elizabeth Street, EN, 6th Floor, Rm 218, Toronto, ON M5G 2C4, Canada(‖). Electronic address: graham.roche-nagle@uhn.ca.
Graham
G
Roche-Nagle
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000671:Amputation, Surgical / Q000379:methods / Q000534:rehabilitation*; D002170:Canada; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007902:Length of Stay / Q000639:trends*; D016014:Linear Models; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data; D026741:Physical Therapy Modalities / Q000639:trends*; D012047:Rehabilitation Centers / Q000458:organization & administration; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D013997:Time Factors