HEMODIALYSIS IS NOT ASSOCIATED WITH PRE-PROSTHETIC INPATIENT REHABILITATION OUTCOMES AFTER DYSVASCULAR LOWER EXTREMITY AMPUTATION: A RETROSPECTIVE COHORT STUDY
Authors: Journeay W. Shane , Marquez Michelle G. , Kowgier Matthew 
Published: September 2020

BACKGROUND: Lower extremity amputation due to complications from peripheral vascular disease and/or diabetes are common and these patients often have multiple comorbidities. Patients with end-stage renal disease receiving hemodialysis (ESRD/HD) are a particularly vulnerable group at risk for amputation. After lower extremity amputation (LEA) surgery, many patients undergo post-operative inpatient rehabilitation to improve their pre-prosthetic functional independence. Given the increased complexity of dysvascular patients living with ESRD/HD compared to those without ESRD/HD, the association of HD with pre-prosthetic inpatient functional outcomes warrants further study.

OBJECTIVE: The objective of this study was to compare the pre-prosthetic functional outcomes and Length of Stay (LOS) among patients with recent dysvascular LEA with and without ESRD/HD.

METHODOLOGY: A retrospective cohort design was used to analyze a group of 167 patients with unilateral, dysvascular limb loss who were admitted to inpatient rehabilitation with 24 of these patients in the ESRD/HD group.  Age, gender, amputation level, amputation side, length of stay (LOS), time since surgery, Functional Independence Measure (FIM) scores (admission and discharge), and Charlson Comorbidity Index (CCI) were collected.

FINDINGS:  There was no difference between patients with dysvascular amputation with and without ESRD/HD in the association of functional outcomes or LOS in this cohort and rehabilitation model. The CCI score was higher in the ESRD/HD group. Multivariate analysis indicated an inverse relationship with age and FIM scores, where increased age was associated with lower Total and Motor FIM at admission and discharge. There were no associations with FIM change. Age was positively associated with LOS. Being female was inversely associated to motor FIM scores at admission and discharge

CONCLUSION: Among patients with recent dysvascular LEA, ESRD/HD is not associated with different functional outcomes or LOS in the pre-prosthetic inpatient rehabilitation setting. This suggests that despite added comorbidity that patients with ESRD/HD may still benefit from inpatient rehabilitation to optimize pre-prosthetic function.

Layman's Abstract

Lower extremity limb loss caused by blood vessel disease and/or diabetes is common. Patients who need amputation often have additional medical conditions that may impact their recovery after surgery. One such condition, is diabetes-related poor kidney function requiring hemodialysis. Patients who attend hemodialysis are particularly vulnerable to limb amputation. After amputation surgery many individuals undergo inpatient rehabilitation to improve self-care and mobility prior to discharge from hospital and before being considered for a prosthesis. In patients who are admitted to rehabilitation hospitals after amputation we understand very little about how the demands of hemodialysis may impact their rehabilitation and how long they stay in a rehabilitation hospital. The objective of this study was to compare patients with amputation due to blood vessel disease and/or diabetes with patients who also require hemodialysis. We studied their functional outcomes and inpatient rehabilitation length of stay in hospital. 167 patients with unilateral, limb loss who were admitted to an inpatient rehabilitation hospital were included in the analysis with 24 of these patients attending hemodialysis.  Age, sex, amputation level, amputation side, length of stay, time since surgery, Functional Independence Measure scores (measure of a patient’s function) and Charlson Comorbidity Index (measure of multiple medical conditions) were collected. We concluded that in patients with recent limb amputation, hemodialysis was not related to different functional outcomes or time in hospital in the inpatient rehabilitation setting. This suggests that despite receiving hemodialysis, patients with recent limb loss may still benefit from inpatient rehabilitation before being considered for a prosthesis.

Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/34471/26580

How To Cite: Journeay W.S., Marquez M.G., Kowgier M. Hemodialysis is not associated with pre-prosthetic inpatient rehabilitation outcomes after dysvascular lower extremity amputation: a retrospective cohort study. Canadian Prosthetics & Orthotics Journal. 2020; Volume 3, Issue 2, No.2. https://doi.org/10.33137/cpoj.v3i2.34471

Corresponding Author: Dr. W. Shane Journeay, PhD, MD, MPH, FRCPC, BC-Occ MedProvidence Healthcare – Unity Health Toronto, 3276 St Clair Avenue East, Toronto ON M1L 1W1E-mail: shane.journeay@utoronto.caORCID: https://orcid.org/0000-0001-6075-3176