Introduction
Following upper extremity amputations, the "Golden Window" of 30 days is a critical period for initiating prosthetic fitting. It is associated with higher rates of successful rehabilitation and return to work. Delays can negatively impact the quality of life and long-term productivity of amputees. Unfortunately, more than 50% of patients fail to obtain prosthetics within this optimal timeframe. Our primary objective was to identify system-related factors that impact delays in prosthetic acquisition in upper extremity amputees.
Methods
We conducted a retrospective analysis using our institution’s 2010-2022 DataDirect Database to identify upper extremity amputees 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. Chart reviews identified the time to prosthetic acquisition, including provisional or preparatory prosthetics. We performed descriptive statistics and multiple logistic regression.
Results
We identified 95 eligible patients. Mean age was 50 years, and mean Elixhauser score was 3.1. Most patients were male (78%) and white (84%). The indications for amputation included trauma (46%), oncologic (31%), and vascular (12%) cases. Plastic and Orthopedic surgeons performed 36% and 59% of the amputations, respectively. 57% of patients received prosthetics. Only 7% of those patients received prosthetics within 30 days of amputation, whereas 76% and 91% received prosthetics within 6 months and 1 year, respectively. Chart review revealed delays in prosthetic acquisition were primarily due to the variable and complex nature of casting, molding, and customization of prosthetic care. Prosthetics were obtained by 59% of plastics patients and 57% of orthopedics patients. Multiple logistic regression did not show significant associations with prosthetic acquisition for age, sex, race, Elixhauser score, indication, and surgeon subspecialty (Table 1).
Tables & Figures
Multiple Logistic Regression
| Parameter | OR (95% CI) | P Value |
| Age at Amputation | 0.9966 (0.9697 to 1.024) | 0.8063 |
| Sex (Ref. Male) | ||
| Female | 1.252 (0.4350 to 3.760) | 0.6797 |
| Race (Ref. White or Caucasian) | ||
| Black or African American | 0.7633 (0.1670 to 3.508) | 0.7223 |
| Other | 1.285 (0.1866 to 11.00) | 0.7996 |
| Elixhauser Score | 1.019 (0.9005 to 1.155) | 0.7676 |
| Indication (Ref. Trauma) | ||
| Oncologic | 1.308 (0.4227 to 4.112) | 0.6409 |
| Vascular | 0.8343 (0.1828 to 3.843) | 0.8121 |
| Infectious | 0.3862 (0.04379 to 2.528) | 0.3376 |
| Other | 2.616 (0.2727 to 60.83) | 0.4482 |
| Surgeon Subspecialty (Ref. Plastic Surgery) | ||
| Orthopedic Surgery | 0.8673 (0.3058 to 2.403) | 0.7851 |
| Acute Care Services | 0.4689 (0.05154 to 3.490) | 0.4612 |