Sociologic factors predict time to discharge in lower limb amputees

By Helen Albert, Senior medwireNews Reporter

Sociologic factors such as marital status and living location before hospitalization are key predictors of time to discharge in male veterans after lower extremity amputation, report researchers.

"It is essential that clinicians recognize the psychosocial factors that affect home discharge and how those conditions can confound the impact of medical conditions," say Margaret Stineman (University of Pennsylvania, Philadelphia, USA) and colleagues.

Building on previous work showing significantly improved recovery in lower-extremity amputees who participate in rehabilitation programs compared with those who do not, Stineman and team investigated what factors predict discharge location in lower-extremity amputee patients who had undergone in-hospital rehabilitation.

The researchers analyzed data collected from 1480 male veterans with acute hospital discharge dates after lower extremity amputation from Veterans Affairs Medical Centers after the "index surgical stay" (time from admission to hospital prior to amputation to first discharge after surgery) ranging from October 2002 to September 2004. The men were aged 68 years on average at discharge and were undergoing amputation for various reasons including acute osteomyelitis, diabetes, and trauma.

Of the patients included in the analysis, 1163 (78.6%) were discharged home after the index surgical stay and 317 were discharged to other locations including extended care (n=278), non-Veterans Affairs hospitals (n=25), other location (n=7), or discharged themselves against medical advice (n=7).

As reported in Physical Medicine and Rehabilitation, Stineman and co-workers found that patients who were married were 51% more likely to be discharged home after the index surgical stay than their unmarried peers.

In addition, patients who were admitted to hospital from home, as opposed to those admitted from another hospital or extended care, were 8.43-fold more likely to be transferred home, and those with higher motor Functional Independence Measure scores had a 23% increased chance for home discharge for every additional 10 points scored. All three of these increases were statistically significant.

Factors predicting a significant decreased likelihood for home discharge after the index surgical stay included evidence of significant local infection, congestive heart failure, or depression, which decreased the chance for home discharge by 43%, 38%, or 37%, respectively. Patients undergoing procedures for ongoing cardiovascular disease also had a significant 45% decreased chance for being discharged home.

For post-lower extremity amputation to be successful "it is important to take into account sociologic factors in addition to clinical factors when caring for patients and planning for their discharge," conclude the authors.

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