Article

We describe prosthetic limb prescription in the first year following lower-limb
amputation and examine the relationship between amputation level, geographic
region, and prosthetic prescription. We analyzed 2005 to 2010 Department of
Veterans Affairs (VA) Inpatient and Medical Encounters SAS data sets, Vital
Status death data, and National Prosthetic Patient Database data for 9,994
Veterans who underwent lower-limb amputation at a VA hospital. Descriptive
statistics and bivariates were examined. Cox proportional hazard models
identified factors associated with prosthetic prescription. Analyses showed that
amputation level was associated with prosthetic prescription. The hazard ratios
(HRs) were 1.41 for ankle amputation and 0.46 for transfemoral amputation
compared with transtibial amputation. HRs for geographic region were Northeast =
1.49, Upper Midwest = 1.26, and West = 1.39 compared with the South (p < 0.001).
African American race, longer length of hospital stay, older age, congestive
heart failure, paralysis, other neurological disease, renal failure, and
admission from a nursing facility were negatively associated with prosthetic
prescription. Being married was positively associated. After adjusting for
patient characteristics, people with ankle amputation were most likely to be
prescribed a prosthesis and people with transfemoral amputation were least
likely. Geographic variation in prosthetic prescription exists in the VA and
further research is needed to explain why.

Langue : ANGLAIS