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The Role of Earlier Receipt of a Lower Limb Prosthesis on Emergency Department Utilization
Taavy A Miller1,2, Rajib Paul1, Melinda Forthofer1
1Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC.
Introduction:
Adverse events after a lower limb amputation (LLA) can negatively affect the rehabilitation process and may lead to emergency department (ED) visits. Earlier receipt of a prosthesis, as compared to delayed or not receiving a prosthesis, may decrease or moderate the risk of increased ED utilization. In addition, adverse events (ie, fall-related injury [FRI]) may be associated with increased health care utilization as measured by ED use. The implication of the timing of prosthesis provision after amputation and reduced ED use is not well established. Obtaining data about ED utilization early post-LLA could assist the rehabilitation team in ensuring timely and appropriate access to improve outcomes.
Objective:
To determine the role that timing of prosthesis receipt has in ED utilization and the association of fall/FRI with health care utilization.
Design:
Retrospective observational cohort using commercial claims data. A logistic regression model was used to assess factors that influence ED utilization post-LLA.
Setting:
Watson/Truven administrative database 2014 to 2016.
Participants:
The study sample consisted of 510 adults age 18 to 64 years with continuous enrollment for 3 years.
Interventions:
Independent variables included age, sex, diabetes status, amputation level, fall diagnosis, and prosthesis receipt. Fall was defined as presence of a diagnosis code in any outpatient procedure after the amputation date.
Main Outcome Measure:
ED use after amputation was defined as the presence of procedure codes that billed for ED services (99281 to 99285).
Results:
Individuals who receive a prosthesis early, within 0 to 3 months, post-LLA were 48% (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.28 to 0.97) less likely to use the ED compared to those who did not receive a prosthesis. Individuals who experienced a fall/FRI had 2.8 (OR 2.86, 95% CI 1.23 to 6.66) times the odds of ED utilization.
Conclusion:
Receipt of a prosthesis reduces the risk of ED use. The current study underscores the value of prostheses during the rehabilitation process after LLA.
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