Prosthetic technology has emerged as a cornerstone of post-amputation rehabilitation, offering individuals restored mobility and improved quality of life. In addition to the standard challenges of surgical recovery, patients face barriers that limit acquisition of prosthetics. Our primary aim was to identify system-related factors that impact prosthetic acquisition in lower extremity amputees.
We conducted a retrospective chart review from a single, quaternary referral center on patients who underwent lower extremity amputations between 2014-2022. Amputee patients were identified based on Current Procedural Terminology (CPT) codes. We excluded patients < 18 years old, those with prior or concurrent major extremity amputations, and those who died < 1 year post-amputation. Primary outcomes included determination of prosthetic acquisition, including preparatory prosthetics, and time to prosthetic acquisition. Additional information collected included surgical indication, amputation type, and performing surgeon subspecialty. Outcomes were compared using multiple logistic regression analysis.
We identified 623 eligible patients. The mean age was 58, mean body mass index (BMI) was 30, and the mean Elixhauser score was 9.1. Our patients were largely male (67%) and white (75%). Most patients underwent below knee amputations (BKA, 66%) and above knee amputations (AKA, 31%). The indications for amputation included infectious (52%), vascular (30%), oncologic (8%), and trauma (5%) cases. Vascular, Orthopedic, and Plastic surgeons performed 58%, 25%, and 11% of the amputations, respectively. 53% of patients received prosthetics. Multiple logistic regression showed significantly reduced prosthetic acquisition rates with age at amputation (OR 0.9881, 95% CI 0.9764 to 0.9997) and vascular surgeon subspecialty (OR 0.4473, 95% CI 0.2357 to 0.8311), and increased rates with Elixhauser score (OR 1.043, 95% CI 1.003 to 1.085) and BKA (OR 1.661, 95% CI 1.128 to 2.455). There were no significant associations between prosthetic acquisition and sex, race, BMI, and indication.
We have demonstrated that patient age and vascular surgeon subspecialty are associated with decreased odds of prosthetic acquisition. Identification of these factors is a necessary first step in the development and implementation of strategies to mitigate barriers to lower extremity prosthetics. This involves the establishment of multidisciplinary teams and an early streamlined approach to prosthetic education and evaluation.