Utility of Removable Rigid Dressings in Decreasing Discharge Narcotic Use and Improving Ambulation Following Below-Knee Amputation

Abstract

Lower extremity amputations are often associated with limited postoperative functionality and postoperative complications. Removable rigid dressings (RRDs) have been used following below-knee amputation (BKA) to improve limb maturation, decrease postoperative complications, reduce time to prosthesis casting, and limit conversion rates to above-knee amputation (AKA). We hypothesized that usage of RRD following BKA will correlate with decreased prescription narcotics required at discharge and improved ambulatory status at follow-up. A retrospective chart review was conducted to identify all patients who underwent BKA performed by the vascular surgery service at a large, acute care hospital between July 2016 and July 2021. Data collected included age, sex, body mass index, conversion to AKA, narcotic prescriptions at discharge, and ambulatory status at follow-up. Between July 2016 and 2021, rate of conversion to AKA was significantly lower in patients who received an RRD (9.3%), as opposed to those who did not (41.5%) (P=0.0002). Narcotic prescriptions at discharge, compared following conversion to morphine equivalents, were also significantly lower in the rigid dressing group compared to patients who did not receive the dressing (50.5 vs. 108.9 morphine eq/24 h, P=0.0019). Furthermore, use of rigid dressing significantly improved ambulatory status at follow-up to 75.9% in RRD patients compared to 29.3% in patients with conventional dressing (P<0.0001). This statistical significance persisted after all patients who were converted to AKA were removed from analysis (79.6% vs. 39.3% ambulatory, P=0.000363). Multivariate analysis revealed that ambulatory status at follow-up was only associated with age more than 80years (P=0.042) and use of postoperative RRD (P=0.001). These findings support the utility of an RRD following BKA to reduce conversion to AKA, reduce narcotic dosages required at discharge, and improve ambulatory status at follow-up.