Abstract
Objective: To investigate the effects of comorbidities (heart disease, diabetes, anemia, hypertension) on functional outcomes and rehabilitation length of stay after total knee or hip replacement or lower-extremity amputation. Design: Retrospective chart review study. Setting: A Veterans Affairs medical center in Texas. Participants: The medical records of 90 patients admitted to inpatient rehabilitation from the orthopedic ward between 1999 and 2002 were reviewed: 50 knee arthroplasty patients (age range, 47–85y; mean, 64.38y), 18 hip arthroplasty patients (age range, 46–85y; mean, 63.3y), and 22 amputees (age, 44–79y; mean, 64.82y). Interventions: Not applicable. Main Outcome Measures: Comorbidity data (heart disease, diabetes, anemia, hypertension) were obtained from the medical history taken prior to surgery. Hemoglobin was measured presurgery and at admission to rehabilitation. The motor subscale of the FIM™ instrument was administered at admission to and discharge from rehabilitation. Length of stay (LOS) in rehabilitation also was recorded. Results: Heart disease, diabetes, and anemia were more common among patients who had amputations than those who had knee and hip arthroplasty. Amputation patients tended to have lower discharge motor FIM scores and longer LOS than knee arthroplasty patients. However, all 3 groups made substantial motor FIM gains (amputation, 19; knee, 23; hip, 20). Patients with chronic anemia had longer rehabilitation LOS and lower discharge motor FIM scores. There were no differences between discharge motor FIM scores and motor FIM gains based on whether a person had heart disease, diabetes, or hypertension. Conclusions: The results indicate that patients admitted to rehabilitation for amputation or hip and knee arthroplasty have the potential to improve motor function regardless of comorbidities. However, the surgery itself and some comorbidities may affect functional recovery and LOS after surgery.
Published Version
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