Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC.
Department of Clinical and Scientific Affairs, Hanger Clinic, Austin, TX.
PM R. 2021 Aug;13(8):819-826. doi: 10.1002/pmrj.12504. Epub 2020 Dec 11.
Adverse events after a lower limb amputation (LLA) can negatively affect the rehabilitation process and may lead to emergency department (ED) visits. Earlier receipt of a prosthesis, as compared to delayed or not receiving a prosthesis, may decrease or moderate the risk of increased ED utilization. In addition, adverse events (ie, fall-related injury [FRI]) may be associated with increased health care utilization as measured by ED use. The implication of the timing of prosthesis provision after amputation and reduced ED use is not well established. Obtaining data about ED utilization early post-LLA could assist the rehabilitation team in ensuring timely and appropriate access to improve outcomes.
To determine the role that timing of prosthesis receipt has in ED utilization and the association of fall/FRI with health care utilization.
Retrospective observational cohort using commercial claims data. A logistic regression model was used to assess factors that influence ED utilization post-LLA.
Watson/Truven administrative database 2014 to 2016.
The study sample consisted of 510 adults age 18 to 64 years with continuous enrollment for 3 years.
Independent variables included age, sex, diabetes status, amputation level, fall diagnosis, and prosthesis receipt. Fall was defined as presence of a diagnosis code in any outpatient procedure after the amputation date.
ED use after amputation was defined as the presence of procedure codes that billed for ED services (99281 to 99285).
Individuals who receive a prosthesis early, within 0 to 3 months, post-LLA were 48% (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.28 to 0.97) less likely to use the ED compared to those who did not receive a prosthesis. Individuals who experienced a fall/FRI had 2.8 (OR 2.86, 95% CI 1.23 to 6.66) times the odds of ED utilization.
Receipt of a prosthesis reduces the risk of ED use. The current study underscores the value of prostheses during the rehabilitation process after LLA.
下肢截肢（LLA）后发生的不良事件可能会对康复过程产生负面影响，并可能导致急诊部（ED）就诊。与延迟或未获得义肢相比，更早地获得义肢可能会降低或减轻 ED 利用率增加的风险。此外，不良事件（例如，与跌倒相关的损伤[FRI]）可能与 ED 使用所衡量的医疗保健利用增加相关。在截肢后义肢提供的时间和减少 ED 使用方面的意义尚不清楚。尽早获得 LLA 后的 ED 使用数据可以帮助康复团队确保及时获得适当的治疗机会，以改善结果。
确定获得义肢的时间对 ED 使用的影响，以及跌倒/FRI 与医疗保健使用的关联。
使用商业索赔数据的回顾性观察队列。使用逻辑回归模型评估影响 LLA 后 ED 使用的因素。
沃森/特鲁文行政数据库 2014 年至 2016 年。
研究样本由 510 名年龄在 18 岁至 64 岁之间的成年人组成，连续入组 3 年。
自变量包括年龄、性别、糖尿病状况、截肢水平、跌倒诊断和义肢接受情况。跌倒的定义是在截肢日期后的任何门诊程序中存在诊断代码。
截肢后 ED 使用定义为存在收取 ED 服务费用的程序代码（99281 至 99285）。
与未接受义肢的患者相比，LLA 后 0 至 3 个月内尽早接受义肢的患者使用 ED 的可能性降低 48%（优势比[OR]0.52，95%置信区间[CI]0.28 至 0.97）。经历跌倒/FRI 的患者使用 ED 的可能性增加 2.8 倍（OR 2.86，95%CI 1.23 至 6.66）。
获得义肢可降低 ED 使用的风险。本研究强调了 LLA 后康复过程中义肢的价值。
