Article

This study's objective was to determine how treatment-, environmental-, and
facility-level characteristics contribute to postdischarge mortality prediction.
The study included 4,153 Veterans who underwent lower-limb amputation in
Department of Veterans Affairs facilities during fiscal years 2003 and 2004.
Veterans were followed 1 yr postamputation. A Cox regression identified
characteristics associated with mortality risk after hospital discharge following
amputation. Older age, higher amputation level, and more comorbidities increased
mortality likelihood. Patients who had inpatient procedures for pulmonary and
renal problems had higher hazards of postdischarge death than those who did not
(hazard ratio [HR] = 2.10, 95% confidence interval [CI] = 1.16-3.77, and HR =
2.22, 95% CI = 1.80-2.74, respectively). Patients who had central nervous system
procedures had higher hazards of death early postdischarge (HR = 2.23, 95% CI =
1.60-3.11) at 0 d, but this association became insignificant by 180 d. Patients
in a surgical intensive care unit (ICU), medical ICU, or medical bed section at
the time of discharge were more likely to die than patients on a surgical bed
section. Patients hospitalized in the Midwest were less likely to die early after
discharge than patients in the Mountain Pacific region, but this regional effect
became insignificant by 90 d. Adding treatment-, environmental-, and
facility-level characteristics contributed additional information to a mortality
risk model.

Langue : ANGLAIS