Impact of Care Fragmentation after Major Lower Extremity Amputation

Abstract

Care fragmentation (CF) is a known risk factor for unplanned readmission, morbidity, and mortality after surgery. The goal of this study was to evaluate the impact of CF on outcomes of major lower extremity amputation for peripheral vascular disease. Health-care Cost and Utilization Project Database for NY (2016) and MD/FL (2016-2017) were queried using International Classification of Diseases 10thedition to identify patients who underwent above the knee-, through the knee-, and below the knee-amputation for peripheral vascular disease. Patients with CF were identified as those with admissions to ≥2 hospitals during the study period. We compared the postamputation outcomes of mortality, readmission rate, length of stay (LOS) and hospital charges. We identified a total of 13,749 encounters of 2,742 patients who underwent major lower extremity amputations. There were 1,624 (59.2%) patients with CF. Patients with CF were younger (68.4years old vs. 69.7years old, P=0.005), with higher Charlson Comorbidity Indices (4.4 vs. 4.1, P<0.001), and required more hospital resources on index admission ($113,699 vs. $91,854, P<0.001). These patients were prevalent for higher 30-, and 90-day readmission rates (34.7% vs. 24.5%, P<0.001 and 54.7% vs. 42.0%, P<0.001, respectively). On their first postamputation readmission, LOS (16.3days vs. 14.7days, P=0.004) and hospital charge ($48,964 vs. $44,388, P=0.002) were significantly higher. Multivariate regression analysis demonstrated that the CF was an independent predictor for 30-day (hazard ratio (HR) 1.65, 95% confidence interval (CI) 1.39-1.96, P<0.001) and 90-day (HR 1.66, 95% CI 1.42-1.95, P<0.001) readmission after the major lower extremity amputation, but not for mortality (HR 0.83, 95% CI 0.56-1.23, P=0.36). CF after major lower extremity amputation is associated with higher readmission rate, LOS, and hospital charge. Collaboration of care providers to maintain continuity of care for peripheral vascular disease patients may enhance quality of care and reduce health care cost.