Institutionalization following diabetes-related lower extremity amputation

Lawrence A. Lavery, William H. Van Houtum, David G Armstrong

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

Purpose: We are unaware of any report in the medical literature that has discussed risk factors for both mortality and discharge disposition following lower extremity amputation (LEA). Our aim was to report risk factors associated with in-hospital mortality and the need for institutional care in diabetics with LEAs. Patients and methods: We abstracted data for every hospitalization for a LEA from January 1 to December 31, 1993 in six metropolitan statistical areas in South Texas. Amputation level was categorized as foot, leg, or thigh. Discharge status categories were: home, nursing home, rehabilitation facility, and death. We used the Kaplan scale of cogent comorbidities to determine the relationship of 12 disease categories and their association with discharge status. Results: There were 1,043 LEAs in South Texas in 1993. Although only 2.3% of the population was admitted from an institutional care facility, over 25% were discharged to one. Of the total population, 18.5% were discharged to a nursing home and 7.0% to a rehabilitation facility, and 5.1% died within the period of hospitalization. We performed a univariate analysis. Factors with a P < 0.25 were included in a stepwise logistic regression analysis with an α of 0.05. High level (leg or thigh) amputation, peripheral vascular disease, male gender, and absence of advanced locomotor impairment were associated with discharge to a rehabilitation facility. For discharge to a nursing home, significant associations were found with: female gender; advanced age (>65 years), single marital status, high level amputation, and advanced cerebrovascular disease and locomotor impairment. Death following LEA was strongly associated with female gender, high level amputation, advanced renal disease, anemia, and congestive heart failure. Conclusion: A significant number of patients either die or require long-term care following a diabetes-related LEA, thus further adding to the burden of this sequela. Several clinical parameters are significantly associated with discharge status after this procedure. More prospective clinical research is needed to verify the associations and to clarify their application in practice.

Original languageEnglish (US)
Pages (from-to)383-388
Number of pages6
JournalAmerican Journal of Medicine
Volume103
Issue number5
DOIs
StatePublished - Nov 1997
Externally publishedYes

Fingerprint

Institutionalization
Amputation
Lower Extremity
Nursing Homes
Hospitalization
Rehabilitation
Home Nursing
Cerebrovascular Disorders
Marital Status
Long-Term Care
Hospital Mortality
Thigh
Population
Comorbidity
Foot
Anemia
Leg
Heart Failure
Kidney
Mortality

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Institutionalization following diabetes-related lower extremity amputation. / Lavery, Lawrence A.; Van Houtum, William H.; Armstrong, David G.

In: American Journal of Medicine, Vol. 103, No. 5, 11.1997, p. 383-388.

Research output: Contribution to journalArticle

Lavery, Lawrence A. ; Van Houtum, William H. ; Armstrong, David G. / Institutionalization following diabetes-related lower extremity amputation. In: American Journal of Medicine. 1997 ; Vol. 103, No. 5. pp. 383-388.
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