Archives of physical medicine and rehabilitation · 2025
Association Between Orthotic Intervention and Reamputation After Minor Lower Extremity Amputation in Patients With Vascular or Systemic Disease: A Nationwide Administrative Database Study in Japan.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Tanabe Yasumasa, Aso Shotaro, Matsui Hiroki, Fushimi Kiyohide, Yasunaga Hideo
Аннотация
OBJECTIVE: To investigate the association between orthotic intervention and reamputation in patients after minor lower extremity amputation (LEA) using a Japanese national inpatient database.
DESIGN: Retrospective cohort study.
SETTING: Acute hospital care.
PARTICIPANTS: A total of 6667 patients (N=6667) who underwent minor LEA from July 2010 to March 2023 were identified using the Diagnosis Procedure Combination database. Eligible patients were categorized into those with and without orthotic intervention during hospitalization.
INTERVENTIONS: Orthotic intervention included adapted footwear, nonremovable offloading devices, prefabricated removable walking braces, and patellar tendon-bearing orthoses during hospitalization.
MAIN OUTCOME MEASURES: The primary outcome was subsequent major ipsilateral LEA after discharge, while secondary outcomes included contralateral LEA and postdischarge mortality. Outcomes were compared between groups using stabilized inverse probability of treatment weighting based on propensity scores.
RESULTS: Of 6667 eligible patients, 581 received orthotic intervention. Stabilized inverse probability of treatment weighting analysis showed that orthotic intervention was associated with lower proportions of ipsilateral LEA (0.6% vs 2.3%; risk difference, -1.6%; 95% CI, -2.4 to -0.7), below-knee LEAs (0.4% vs 1.9%; risk difference, -1.4%; 95% CI, -2.1 to -0.7), and mortality (3.6% vs 5.6%; risk difference, -2.0%; 95% CI, -4.0 to -0.1). No significant differences were observed in the proportions of above-knee or contralateral LEAs.
CONCLUSIONS: Orthotic intervention is associated with reduced subsequent ipsilateral LEA and postdischarge mortality. However, because of the inherent limitations of the administrative database, including unavailable data on orthotic device types, actual usage, patient adherence, and precise amputation levels, these findings should be interpreted as associations.
DESIGN: Retrospective cohort study.
SETTING: Acute hospital care.
PARTICIPANTS: A total of 6667 patients (N=6667) who underwent minor LEA from July 2010 to March 2023 were identified using the Diagnosis Procedure Combination database. Eligible patients were categorized into those with and without orthotic intervention during hospitalization.
INTERVENTIONS: Orthotic intervention included adapted footwear, nonremovable offloading devices, prefabricated removable walking braces, and patellar tendon-bearing orthoses during hospitalization.
MAIN OUTCOME MEASURES: The primary outcome was subsequent major ipsilateral LEA after discharge, while secondary outcomes included contralateral LEA and postdischarge mortality. Outcomes were compared between groups using stabilized inverse probability of treatment weighting based on propensity scores.
RESULTS: Of 6667 eligible patients, 581 received orthotic intervention. Stabilized inverse probability of treatment weighting analysis showed that orthotic intervention was associated with lower proportions of ipsilateral LEA (0.6% vs 2.3%; risk difference, -1.6%; 95% CI, -2.4 to -0.7), below-knee LEAs (0.4% vs 1.9%; risk difference, -1.4%; 95% CI, -2.1 to -0.7), and mortality (3.6% vs 5.6%; risk difference, -2.0%; 95% CI, -4.0 to -0.1). No significant differences were observed in the proportions of above-knee or contralateral LEAs.
CONCLUSIONS: Orthotic intervention is associated with reduced subsequent ipsilateral LEA and postdischarge mortality. However, because of the inherent limitations of the administrative database, including unavailable data on orthotic device types, actual usage, patient adherence, and precise amputation levels, these findings should be interpreted as associations.