ABSTRACT
Vascular patients, an inherently older, frail population, account for >80% of major lower extremity amputations (transtibial or transfemoral) in the United States. Retrospective data have shown that early physical therapy and discharge to an acute rehabilitation facility decreases the postoperative length of stay (LOS) and expedites ambulation. In the present study, we sought to determine whether patients treated with the lower extremity amputation protocol (LEAP) will have improved outcomes. We performed a nonrandomized prospective study of vascular patients undergoing an amputation from January 2019 to February 2020. Patients who were nonambulatory or had undergone a previous contralateral major amputation were excluded. LEAP is a multidisciplinary team approach to the perioperative care of amputees using an outlined protocol. The prospective patients were compared with historic controls treated before the initiation of LEAP (January 2016 to December 2018). The primary outcomes included the postoperative LOS, time to receipt of a prosthesis, and time to ambulation. Of the 141 included patients, 130 were in the retrospective group and 11 in the LEAP group. The demographics and comorbidities were similar. All 11 LEAP patients had undergone a below-the-knee amputation, with 1 requiring revision to an above-the-knee amputation. Of the 130 retrospective patients, 122 (94%) had undergone a below-the-knee amputation, with 1 requiring revision to an above-the-knee amputation. The LEAP patients were more likely to be discharged to acute rehabilitation (100% vs 27%; P < .001), receive a prosthesis (100% vs 45%; P < .001), and ambulate with the prosthesis (100% vs 43%; P < .001). The LEAP patients had received physical therapy 2 days sooner than had the retrospective controls (P = .006) with a shorter postoperative LOS (3 days vs 6 days; P < .001). Of the patients who had received their prosthesis, the LEAP patients had received their prosthesis, on average, 2 months sooner than had the retrospective cohort (81 ± 39 days vs 137 ± 97 days, respectively; P = .002) and had ambulated with their prosthesis sooner (86 ± 53 days vs 146 ± 104 days, respectively; P = .002). No differences were found in the incidence of surgical site complications or unplanned readmissions between the two groups. The results from the present pilot study have demonstrated that the use of LEAP can significantly decrease postoperative LOS and expedite the time to independent ambulation with a prosthesis for vascular patients undergoing a major lower extremity amputation. These findings suggest a powerful ability to bridge the healthcare gap for this high-risk, underserved, and ethnically diverse population using a disease-specific standardized protocol.
ABSTRACT
OBJECTIVES: Dysvascular patients account for >80% of major amputations in the US. We sought to determine if early mobilization and discharge disposition decreased post-operative hospital length of stay (PO-LOS) and expedited independent ambulation. METHODS: A retrospective review of dysvascular patients undergoing major amputations was performed. Primary outcomes included PO-LOS, discharge disposition, and days to ambulation. RESULTS: 130 patients were included. Patients evaluated by Physical Therapy (PT) within 1 day of formal amputation had decreased PO-LOS (5.6 vs 6.5 days, p = 0.029). Patients discharged to rehab had a shorter PO-LOS (4 days) than those discharged to SNF or home (8 and 5 days, respectively; p = 0.008). Time to ambulation was shorter for patients discharged to rehab (109 days vs home = 153 days; SNF = 175 days; p = 0.033). CONCLUSION: Modifiable factors, including early PT and rehab placement, decreased PO-LOS and expedited time to ambulation. A need exists for a standardized multidisciplinary team approach to improve outcomes.
