Hemodialysis is Not Associated With Pre-prosthetic Inpatient Rehabilitation Outcomes After Dysvascular Lower Extremity Amputation: A Retrospective Cohort Study

W S Journeay; M G Marquez; M Kowgier

doi:10.33137/cpoj.v3i2.34471

Hemodialysis is Not Associated With Pre-prosthetic Inpatient Rehabilitation Outcomes After Dysvascular Lower Extremity Amputation: A Retrospective Cohort Study

Can Prosthet Orthot J. 2020 Sep 4;3(2):34471. doi: 10.33137/cpoj.v3i2.34471. eCollection 2020.

Authors

W S Journeay^{1

2}, M G Marquez³, M Kowgier⁴

Affiliations

¹ Providence Healthcare - Unity Health Toronto, Toronto, ON, Canada.
² Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Canada.
³ Department of Anatomy and Cell Biology, McGill University, Montreal, Canada.
⁴ Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.

Abstract

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.

Keywords: Charlson comorbidity index; Dysvascular amputation; End-stage renal disease; Hemodialysis; Inpatient rehabilitation.