Rehabilitation of amputees with end-stage renal disease. Functional outcome and cost.

Abstract

A retrospective chart review was performed on 19 lower extremity amputees with end-stage renal disease (ESRD) on dialysis and 19 controls with peripheral vascular disease (PVD) without ESRD to compare functional outcome with costs of rehabilitation. The groups were similar demographically and by etiology, level and side of amputation. Functional outcome as measured by Functional Independence Measure (FIM) scores did not show a significant difference between the groups on admission (P = 0.19), discharge (P = 0.20) or change in FIM (P = 0.94). The percentage of successful prosthetic ambulators (P = 0.74) and the duration of prosthetic training (P = 0.60) were not statistically different between the groups. Cost as measured by total hospital length of stay (LOS) was not significantly different (P = 0.43), but the renal group showed a significantly longer acute hospital LOS (P = 0.02) and a trend for a shorter rehabilitation LOS (P = 0.08). Mortality, discharge setting and home care arrangements on discharge were similar for the groups. The renal group had a significantly greater number of co-morbidities than the non-renal group (P = 0.002). Despite the large number of medical problems, amputees on renal dialysis admitted to acute rehabilitation had similar outcomes with similar costs to amputees with PVD without renal failure.