INSTITUTIONALIZATION FOLLOWING DIABETES-RELATED LOWER-EXTREMITY AMPUTATION

PURPOSE: We are unaware of any report in the medical literature that h as discussed risk factors for both mortality and discharge disposition following lower extremity amputation (LEA). Our aim was to report ris k factors associated with in-hospital mortality and the need for insti tutional care in diabetics with LEAs. PATIENTS AND METHODS: We abstrac ted data for every hospitalization for a LEA from January 1 to Decembe r 31, 1993 in six metropolitan statistical areas in South Texas. Amput ation level was categorized as foot, leg, or thigh. Discharge status c ategories were: home, nursing home, rehabilitation facility, and death . We used the Kaplan scale of cogent comorbidities to determine the re lationship of 12 disease categories and their association with dischar ge status. RESULTS: There were 1,043 LEAs in South Texas in 1993. Alth ough only 2.3% of the population was admitted from an institutional ca re 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 perfo rmed a univariate analysis. Factors with a P <0.25 were included in a stepwise logistic regression analysis with an alpha of 0.05. High leve l (leg or thigh) amputation, peripheral vascular disease, male gender, and absence of advanced locomotor impairment were associated with dis charge 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 advance d cerebrovascular disease and locomotor impairment. Death following LE A was strongly associated with female gender, high level amputation, a dvanced renal disease, anemia, and congestive heart failure. CONCLUSIO N: A significant number of patients either die or require long-term ca re following a diabetes-related LEA, thus further adding to the burden of this sequela. Several clinical parameters are significantly associ ated with discharge status after this procedure. More prospective clin ical research is needed to verify the associations and to clarify thei r application in practice. (C) 1997 by Excerpta Medica, Inc.