Determinants of Prosthetic Referral and Functional Mobility for Vascular Patients after Major Lower Extremity...

The incidence of major lower extremity amputation (MLA) is related to increasing rates of diabetes mellitus and peripheral arterial disease. Factors which influence functional mobility following MLA are less known. We aimed to investigate determinants of improved prosthetic fitting rate and greater functional mobility following MLA in patients with vascular disease.

We performed a retrospective analysis of adults who underwent MLA for vascular disease at a tertiary center from June 2016 to November 2022. Patients were stratified by prosthesis fitting completion. Functional mobility was recorded using Prosthetic Limb Users Survey of Mobility (PLUS-M) scoring. Multivariate logistic regression was performed to identify factors associated with improved functional mobility.

Three hundred sixty-one amputations in 350 patients were included in the study. Prosthesis fitting was completed following 134 (37.1%) amputations. Ninety-two patients had documented ambulation after fitting, and 82 (61.2%) patients recorded a PLUS-M score. Thirty-four PLUS-M scores (41.5%) achieved mobility above mean normative PLUS-M score, and 48 (58.5%) did not. Patients with above-average mobility had fewer comorbidities, had a higher incidence of prior coronary artery bypass graft (CABG), were more likely to have private insurance or Medicare, and were more likely to be discharged home or to acute rehab instead of a skilled nursing facility. On multivariate logistic regression, hypertension, cerebrovascular disease, and Medicaid insurance were associated with below-average mobility.

In patients with vascular disease who undergo MLA, prior CABG and private or Medicare insurance were associated with above-average mobility. Efforts to achieve home discharge or acute rehab following MLA may improve functional outcomes.