Discharge destination after dysvascular lower-limb amputations
Discharge destination after dysvascular lower-limb amputations
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DOI：
10.1053/s0003-9993(03)00291-0
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发表时间：
2003-11-01
影响因子：
4.3
通讯作者：
MacKenzie, EJ
中科院分区：
文献类型：
--
作者：
Dillingham, TR;Pezzin, LE;MacKenzie, EJ
目的：研究血管障碍截肢术后急性护理康复服务的使用情况。设计：分析马里兰州卫生服务成本审查委员会的州立医院出院数据。设置：马里兰州全州出院数据库。参与者：1986至1997年间非联邦急性护理医院出院的患者，其下肢截肢程序代码(ICD-9-CM代码84.12-.19)，不包括脚趾截肢。因创伤、骨恶性肿瘤或先天畸形而截肢的患者被排除在外。干预措施：不适用。主要观察指标：急诊后护理服务利用率。结果：在此期间，有16,759名患者因截肢手术出院。平均年龄为69.3+/-14.3岁，男性占51.9%。黑人占样本的42.4%。42.0%的截肢者有糖尿病，66.1%的截肢者有外周血管疾病。截肢发生在足部(19.4%)、胫骨(38.1%)和股骨(42.4%)水平。最大比例(40.6%)的患者在急性护理后直接出院，37.4%的患者去疗养院，9.2%的患者回家接受家庭护理，9.6%的患者出院到住院康复单元。从1986年到1997年，直接出院的比例呈下降趋势，而疗养院和住院患者的康复意向呈上升趋势。结论：血管功能障碍截肢术后住院患者康复使用频率较低。有必要进行前瞻性研究，以检查在不同护理环境中接受康复服务的人的结果，以确定恢复功能的最佳康复地点。
Objective: To examine postacute care rehabilitation services use after dysvascular amputation.Design: State-maintained hospital discharge data from the Maryland Health Services Cost Review Commission were analyzed.Setting: Maryland statewide hospital discharge database.Participants: Persons discharged from nonfederal acute care hospitals from 1986 to 1997 with a procedure code for lower-limb amputation (ICD-9-CM code 84.12-.19), excluding toe amputations. Those persons with amputations due to trauma, bone malignancy, or congenital anomalies were excluded.Interventions: Not applicable.Main Outcome Measure: Postacute care service utilization.Results: There were 16,759 discharges with an amputation procedure over this period. The average age was 69.3+/-14.3 years, and 51.9% were men. Black persons comprised 42.4% of the sample. Diabetes was present in 42.0%, and peripheral vascular disease was noted for 66.1% of amputees. Amputations were at the foot (19.4%), transtibial (38.1%), and transfemoral (42.4%) levels. The largest proportion (40.6%) of patients was discharged directly home after acute care, 37.4% went to a nursing home, 9.2% went home with home care, and 9.6% were discharged to an inpatient rehabilitation unit. From 1986 to 1997, there were downward trends in the rate of discharges directly home and corresponding upward trends in nursing home and inpatient rehabilitation dispositions.Conclusions: Inpatient rehabilitation use is infrequent after dysvascular amputation. Prospective studies are necessary to examine outcomes for persons receiving rehabilitation services in different care settings to define the optimal rehabilitation venue for functional restoration.