{"title":"大城市大型假肢机构医疗保险患者非创伤性下肢截肢后的死亡率","authors":"Max Donahue Krueger","doi":"10.1097/jpo.0000000000000463","DOIUrl":null,"url":null,"abstract":"ABSTRACT Introduction Approximately 75% of Medicare patients sustain vascular-related major lower-limb amputations and die within 5 years postamputation. Studies have examined factors influencing mortality rates at 1 and 5 years postamputation. Lower-limb prosthesis users are assigned Medicare Functional Classification Levels (i.e., K-levels) at prosthetic evaluations. Higher K-level patients tend to ambulate faster and have lower comorbidity index scores. To date, no known studies have examined K-level classification as a mortality indicator. The study objective was to examine mortality rates and major nontraumatic lower-limb amputation Medicare patient demographics in the Chicago metropolitan area. A secondary goal was to explore how K-level classification coincides with mortality rates. Materials and Methods A total of 2833 lower-limb prosthetic patient evaluation records ranging from June 2014 to February 2019 were exported from Futura Practice Management. Only Medicare patients with major-lower limb amputations and information related to vascular etiologies were considered. Type and comorbidity quantity were assessed per record. K-levels used were those recorded; raw Amputee Mobility Predictor scores were not considered. The patients' living status was based on the dates of death found in the MYCGS database; living patients were assigned dates of database access. The number of days the patient survived postamputation was calculated as the difference between their living status and date of death. Descriptive statistics, binary logistic regression models with a confidence interval of 95%, and 5-year Kaplan-Meier plot were generated in SPSS. A truth table was created to determine eligible records for use in plots and mortality calculations at 5 years postamputation. Results A total of 502 patients were included after inclusion criteria application. Overall mortality rates at 1 year and 5 years postamputation were 33.6% and 73.59%, respectively. Transtibial and transfemoral mortality rates for 1 year and 5 years postamputation were 33.07%, 72.32%, 35.59%, and 77.78%, respectively. Comorbidity quantity had no statistical significance or influence on mortality rates at 1 year and 5 years postamputation. End-stage renal disease (ESRD) and heart condition had greater mortality association and increased mortality by a factor of 2.3 and 2.4, respectively. Kaplan-Meier results suggest that as K-level classification increases, so too does cumulative survival. Conclusions One-year and 5-year overall mortality rates fell within the ranges reported in the literature (33.6%, 73.59%). Transtibial and transfemoral mortality at 1 and 5 years postamputation were 33.07%, 72.32%, 35.59%, and 77.78%, respectively. ESRD and heart condition were indicators of mortality relative to other comorbid conditions. Higher K-level was associated with greater survival probability per Kaplan-Meier results. Clinical Relevance ESRD demonstrated greater association with mortality after 1 year postamputation, and heart condition had a greater association with mortality at 5 years postamputation, suggesting that patients should be encouraged to adopt healthier lifestyles/choices. Their activity level and corresponding K-level suggest that goals driven toward K-level improvement may in fact improve their survival and reduce mortality.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"21 1","pages":"0"},"PeriodicalIF":0.4000,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Mortality After Nontraumatic Major Lower-Limb Amputations in Medicare Patients at a Large Metropolitan Prosthetic Facility\",\"authors\":\"Max Donahue Krueger\",\"doi\":\"10.1097/jpo.0000000000000463\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"ABSTRACT Introduction Approximately 75% of Medicare patients sustain vascular-related major lower-limb amputations and die within 5 years postamputation. Studies have examined factors influencing mortality rates at 1 and 5 years postamputation. Lower-limb prosthesis users are assigned Medicare Functional Classification Levels (i.e., K-levels) at prosthetic evaluations. Higher K-level patients tend to ambulate faster and have lower comorbidity index scores. To date, no known studies have examined K-level classification as a mortality indicator. The study objective was to examine mortality rates and major nontraumatic lower-limb amputation Medicare patient demographics in the Chicago metropolitan area. A secondary goal was to explore how K-level classification coincides with mortality rates. Materials and Methods A total of 2833 lower-limb prosthetic patient evaluation records ranging from June 2014 to February 2019 were exported from Futura Practice Management. Only Medicare patients with major-lower limb amputations and information related to vascular etiologies were considered. Type and comorbidity quantity were assessed per record. K-levels used were those recorded; raw Amputee Mobility Predictor scores were not considered. The patients' living status was based on the dates of death found in the MYCGS database; living patients were assigned dates of database access. The number of days the patient survived postamputation was calculated as the difference between their living status and date of death. Descriptive statistics, binary logistic regression models with a confidence interval of 95%, and 5-year Kaplan-Meier plot were generated in SPSS. A truth table was created to determine eligible records for use in plots and mortality calculations at 5 years postamputation. Results A total of 502 patients were included after inclusion criteria application. Overall mortality rates at 1 year and 5 years postamputation were 33.6% and 73.59%, respectively. Transtibial and transfemoral mortality rates for 1 year and 5 years postamputation were 33.07%, 72.32%, 35.59%, and 77.78%, respectively. Comorbidity quantity had no statistical significance or influence on mortality rates at 1 year and 5 years postamputation. End-stage renal disease (ESRD) and heart condition had greater mortality association and increased mortality by a factor of 2.3 and 2.4, respectively. Kaplan-Meier results suggest that as K-level classification increases, so too does cumulative survival. Conclusions One-year and 5-year overall mortality rates fell within the ranges reported in the literature (33.6%, 73.59%). Transtibial and transfemoral mortality at 1 and 5 years postamputation were 33.07%, 72.32%, 35.59%, and 77.78%, respectively. ESRD and heart condition were indicators of mortality relative to other comorbid conditions. Higher K-level was associated with greater survival probability per Kaplan-Meier results. Clinical Relevance ESRD demonstrated greater association with mortality after 1 year postamputation, and heart condition had a greater association with mortality at 5 years postamputation, suggesting that patients should be encouraged to adopt healthier lifestyles/choices. Their activity level and corresponding K-level suggest that goals driven toward K-level improvement may in fact improve their survival and reduce mortality.\",\"PeriodicalId\":53702,\"journal\":{\"name\":\"Journal of Prosthetics and Orthotics\",\"volume\":\"21 1\",\"pages\":\"0\"},\"PeriodicalIF\":0.4000,\"publicationDate\":\"2023-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Prosthetics and Orthotics\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1097/jpo.0000000000000463\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Prosthetics and Orthotics","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/jpo.0000000000000463","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
大约75%的医保患者维持与血管相关的下肢截肢并在截肢后5年内死亡。研究调查了影响截肢后1年和5年死亡率的因素。下肢假体使用者在假体评估时被分配医疗保险功能分类水平(即k水平)。高k水平的患者往往走得更快,合并症指数得分更低。迄今为止,还没有已知的研究将k级分类作为死亡率指标。研究的目的是检查死亡率和主要的非创伤性下肢截肢医疗保险患者在芝加哥大都会地区的人口统计。第二个目标是探索k级分类如何与死亡率一致。材料与方法从Futura Practice Management导出2014年6月至2019年2月共2833份下肢假肢患者评估记录。仅考虑有大下肢截肢和血管病因相关信息的医保患者。评估每条记录的类型和合并症数量。使用的k -水平为记录值;未考虑原始截肢者活动能力预测评分。患者的生活状态基于MYCGS数据库中发现的死亡日期;在世患者被指定访问数据库的日期。患者截肢后存活的天数计算为其生活状态与死亡日期之间的差异。在SPSS中生成描述性统计、置信区间为95%的二元logistic回归模型和5年Kaplan-Meier图。创建了真值表,以确定在截肢后5年的地块和死亡率计算中使用的合格记录。结果按纳入标准纳入502例患者。截肢后1年和5年的总死亡率分别为33.6%和73.59%。术后1年、5年经胫和经股死亡率分别为33.07%、72.32%、35.59%和77.78%。合并症数量对截肢后1年和5年的死亡率无统计学意义。终末期肾病(ESRD)和心脏病的死亡率相关性更大,死亡率分别增加了2.3和2.4倍。Kaplan-Meier结果表明,随着k级分类的增加,累积存活率也会增加。结论1年和5年总死亡率均在文献报道范围内(33.6%和73.59%)。术后1年、5年经胫和经股死亡率分别为33.07%、72.32%、35.59%和77.78%。ESRD和心脏状况是相对于其他合并症的死亡率指标。根据Kaplan-Meier结果,较高的k水平与较高的生存概率相关。临床相关性ESRD与截肢后1年的死亡率有更大的相关性,而心脏状况与截肢后5年的死亡率有更大的相关性,这表明应该鼓励患者采取更健康的生活方式/选择。他们的活动水平和相应的k水平表明,以提高k水平为目标实际上可能提高他们的存活率并降低死亡率。
Mortality After Nontraumatic Major Lower-Limb Amputations in Medicare Patients at a Large Metropolitan Prosthetic Facility
ABSTRACT Introduction Approximately 75% of Medicare patients sustain vascular-related major lower-limb amputations and die within 5 years postamputation. Studies have examined factors influencing mortality rates at 1 and 5 years postamputation. Lower-limb prosthesis users are assigned Medicare Functional Classification Levels (i.e., K-levels) at prosthetic evaluations. Higher K-level patients tend to ambulate faster and have lower comorbidity index scores. To date, no known studies have examined K-level classification as a mortality indicator. The study objective was to examine mortality rates and major nontraumatic lower-limb amputation Medicare patient demographics in the Chicago metropolitan area. A secondary goal was to explore how K-level classification coincides with mortality rates. Materials and Methods A total of 2833 lower-limb prosthetic patient evaluation records ranging from June 2014 to February 2019 were exported from Futura Practice Management. Only Medicare patients with major-lower limb amputations and information related to vascular etiologies were considered. Type and comorbidity quantity were assessed per record. K-levels used were those recorded; raw Amputee Mobility Predictor scores were not considered. The patients' living status was based on the dates of death found in the MYCGS database; living patients were assigned dates of database access. The number of days the patient survived postamputation was calculated as the difference between their living status and date of death. Descriptive statistics, binary logistic regression models with a confidence interval of 95%, and 5-year Kaplan-Meier plot were generated in SPSS. A truth table was created to determine eligible records for use in plots and mortality calculations at 5 years postamputation. Results A total of 502 patients were included after inclusion criteria application. Overall mortality rates at 1 year and 5 years postamputation were 33.6% and 73.59%, respectively. Transtibial and transfemoral mortality rates for 1 year and 5 years postamputation were 33.07%, 72.32%, 35.59%, and 77.78%, respectively. Comorbidity quantity had no statistical significance or influence on mortality rates at 1 year and 5 years postamputation. End-stage renal disease (ESRD) and heart condition had greater mortality association and increased mortality by a factor of 2.3 and 2.4, respectively. Kaplan-Meier results suggest that as K-level classification increases, so too does cumulative survival. Conclusions One-year and 5-year overall mortality rates fell within the ranges reported in the literature (33.6%, 73.59%). Transtibial and transfemoral mortality at 1 and 5 years postamputation were 33.07%, 72.32%, 35.59%, and 77.78%, respectively. ESRD and heart condition were indicators of mortality relative to other comorbid conditions. Higher K-level was associated with greater survival probability per Kaplan-Meier results. Clinical Relevance ESRD demonstrated greater association with mortality after 1 year postamputation, and heart condition had a greater association with mortality at 5 years postamputation, suggesting that patients should be encouraged to adopt healthier lifestyles/choices. Their activity level and corresponding K-level suggest that goals driven toward K-level improvement may in fact improve their survival and reduce mortality.
期刊介绍:
Published quarterly by the AAOP, JPO: Journal of Prosthetics and Orthotics provides information on new devices, fitting and fabrication techniques, and patient management experiences. The focus is on prosthetics and orthotics, with timely reports from related fields such as orthopaedic research, occupational therapy, physical therapy, orthopaedic surgery, amputation surgery, physical medicine, biomedical engineering, psychology, ethics, and gait analysis. Each issue contains research-based articles reviewed and approved by a highly qualified editorial board and an Academy self-study quiz offering two PCE''s.