Factors that influence time to prosthesis receipt after lower limb amputation: A Cox proportional hazard model regression.

BACKGROUND

Early mobility, functional independence, and ambulation are associated benefits after lower limb amputation (LLA), whereas an increased risk of clinical complications is associated with no prosthesis.

OBJECTIVE

To describe time to prosthesis receipt after amputation and to assess the impact of patient demographic and health factors on the rate of prosthesis receipt within 12 months post LLA.

DESIGN

A retrospective cohort analysis using commercial administrative claims data. Kaplan-Meier and Cox proportional-hazards models were applied to assess time to prosthesis receipt.

SETTING

Watson/Truven administrative database 2014-2016.

PARTICIPANTS

Adults aged 18-64 years with LLA who maintained their current insurance enrollment for 12 months after amputation.

INTERVENTIONS: Independent variables included diabetes/vascular disease status, amputation level, age, gender, and region.

MAIN OUTCOME MEASURES: Prosthesis receipt was defined based on the presence of codes billed for prosthesis services. Time was measured in days from date of amputation surgery.

RESULTS

Among the sample, 510 individuals maintained insurance enrollment for 12 months after amputation, of which 443 individuals received a prosthesis within that period (79% below knee and 21% above knee). The adjusted average rate of time to prosthesis receipt was 138 (95% confidence interval [CI]: 113-185) days. Individuals with diabetes/vascular disease were 22% (hazard ratio: 1.22, 95% CI: 1.02-1.49) more likely to receive a prosthesis earlier than individuals without diabetes/vascular disease and women received a prosthesis later than men at 141 (95% CI: 126-162) days versus 106 (95% CI: 96-119) days, respectively.

CONCLUSIONS

This study expands the understanding of factors that influence the likelihood of receiving a prosthesis along with the timing of prosthesis receipt after LLA among commercially insured adults. At least half of this sample received a prosthesis within 5 months or less. Disparities in timing and access to a prosthesis based on amputation level and gender were noted; future efforts are needed to address these issues.