Behrouz Fard, Jan H.B. Geertzen, Pieter U. Dijkstra
Rehabilitation Medicine, University Medical Center Groningen, , 9700RB Groningen, The Netherlands. E-mail: b.fard@umcg.nl
DOI: 10.2340/16501977-2631

Objective: To report the rates of persons returning home within one year following dysvascular major amputation of the lower limb in the Netherlands, and to identify factors associated with returning home directly after hospital admission and after discharge to care facilities.
Design: Retrospective cohort study.
Patients: Dysvascular major amputation of the lower limb, n = 382, mean age 71. 9 years (standard deviation (SD) 12. 5 years), 65% male.
Methods: Medical records of all persons undergoing major amputation of the lower limb in 2012–2013 in 12 hospitals in Northern Netherlands were reviewed. Odds ratios (OR) were calculated using multivariate logistic regression.
Results: Among persons admitted from home and surviving the hospital admission, 21% returned home, with higher odds of returning home being associated with living with a partner (OR = 2. 8, p = 0. 006) and younger age (< 65 years). Among those discharged to care and surviving the first year, 77% returned home within one year after amputation, with higher odds being associated with younger age (<75 years) and admission to inpatient rehabilitation (OR = 10. 6, p = 0. 004) or geriatric rehabilitation in skilled nursing facilities (OR = 3. 5, p = 0. 030).
Conclusion: Four out of 5 persons surviving dysvascular major amputation of the lower limb return home within one year, although a majority requires care in either inpatient rehabilitation or a skilled nursing facilities setting.

Persons undergoing lower limb amputation due to vascular disease and/or diabetes mellitus are typically elderly and medically frail. Most are admitted from home, and approximately one-fifth return home after hospital admission for amputation surgery, especially those with a partner and younger than 65 years. Among those who are unable to return home in the first instance, eventually nearly 4 out of 5 return to independent living within one year after amputation. It should be borne in mind, however, that one-third of persons does not survive up to one year after amputation and that the aforementioned number of people returning home applies only to those who survive the first year. The healthcare system in the Netherlands provides dedicated rehabilitation programmes for elderly patients, with lower intensity training compared with traditional inpatient rehabilitation programmes. In this study, ”geriatric rehabilitation” seemed effective in terms of improving the chances of persons’ return to home after a dysvascular major amputation of the lower limb.

Appendix S1