Clinical Sciences/Health Conditions
Akin Beckley, MD
MD
Columbia University Irving Medical Center
New York, New York, United States
Christopher K. Wong, PT, PhD, Certified Orthopedic Clinical Specialist
Professor, Rehabilitation & Regenerative Medicine
Columbia University Irving Medical Cente
New York, New York, United States
Emma Steel, PT, DPT
Physical Therapist
Columbia University Irving Medical Center
New York, New York, United States
After lower limb amputation (LLA), many people are discharged quickly from the hospital to await healing. Prolonged immobilization increases costs and hospital length of stay (LOS). Rehabilitation physicians (PMR), physical (PT) and occupational (OT) therapies, and peer-support play important peri-operative roles as described in recent LLA Clinical Practice Guidelines (CPG). This study piloted extraction of relevant medical record data for people with delayed discharges after LLA.
Design:
Cohort study reviewed medical records from 6 months at one major medical center that met the inclusion criteria: 1) new LLA, 2) hospital LOS beyond post-operative day 3. Medical record data included general individual demographics, rehabilitation referrals, and activity measure for post-acute care (AMPAC) mobility, and LOS and disposition. Analysis was descriptive in nature.
Results:
The 11 patients (9 with complete data) included 8 male and 3 females (4 white, 7 non-white) with mean age 70.1±14.5 y who scored 7.8+3.7 on the Charlson Comorbidity Index, most rated severely compromised with scores >5. Most patients had diabetes (8) and/or peripheral artery disease (9). Four received PMR consults, all received PT, 10 received OT, but only 1 had recreational therapy-support group consult. Mean AMPAC score was 14.1+5.3 at evaluation and increased by 0.3+4.4, with 4/11 improving, 2/11 declining, 3/11 unchanged, and 2/11 without discharge scores. The 11 patients were discharged 9.5+7.6 d post-op after mean 13.4+8.2 d hospital LOS; 3 to home, 2 to acute rehabilitation, and 6 to skilled nursing facilities (SNF).
Conclusion:
Identifying people with delayed discharges after LLA was feasible and patients with lower AMPAC scores and higher CCI were more likely to need inpatient rehabilitation. Nearly all received PT/OT however most did not receive PMR consults to coordinate ongoing care; only one was referred for peer support. Most were discharged to SNFs, unlike previous studies which indicated patients transitioned to acute rehabilitation.
