LAS VEGAS —Transfemoral amputees who can walk independently prior to amputation are more likely to receive prostheses after amputation, according to data presented at the American Orthotic & Prosthetic Association World Congress.
“The odds of receiving a prosthesis was 30 times higher if the people were walking independently prior to the amputation,” Kenton Kaufman, PhD, PE, of the Mayo Clinic in Rochester, Minnesota, said. “Also, the time lapsed after surgery was associated with an increased probability for receiving a prosthesis for the first 3 months after the amputation.”
He said the two key reasons adults with transfemoral amputations fail to receive prostheses are mobility and mortality. Additionally, a 1-decade increase in age is associated with a 54% decrease in the likelihood that the patient would be fitted for a prosthesis.
“There is some indication that, for example, veterans under the age of 75 years are 5 times more likely to get a prosthesis than veterans that are older than 85 years. … There are conditions of mobility or balance that affect a person’s ability to get a prosthesis.”
To identify the pre-amputation characteristics associated with the likelihood of receiving a prosthesis after amputation, Kaufman and colleagues analyzed the medical records and administrative data from two clinical care providers — the Mayo Clinic and Olmsted Medical Center — in southeast Minnesota. In all, the records included data on 525,000 individuals and 6.8 million person-years of observation.
The researchers focused on 93 individuals who had transfemoral amputations between 1987 and 2013. They collected data on amputation etiology, year of amputation, patient’s living situation and status of pre-amputation mobility. Among patients who had been living independently prior to amputation, 79% received prostheses, compared to 12% who were not living independently. Among patients who had used assistive devices, 96% of patients did not receive a prosthesis.
He said the primary reasons for not prescribing prostheses were mobility, mortality, comorbidities, mental status or patient fragility or weakness. According to Kaufman, 20 patients had other reasons or no documentation was available.
“We all hope that our patients get a prosthetic prescription, and that after an amputation everyone gets a prosthesis, but that in fact is not the case,” Kaufman said. – by Jason Laday
Kaufman K, et al. Predictors of receiving a prosthesis for adults with above-knee amputations. Presented at: American Orthotic & Prosthetic Association World Congress; Sept. 6-9, 2017; Las Vegas.
Disclosure: Kaufman reports he received funding from American Orthotic & Prosthetic Association and the NIH Rochester Epidemiology Project.