The effectiveness of inpatient rehabilitation in the acute postoperative phase of care after transtibial or transfemoral amputation: study of an integrated health care delivery system

Arch Phys Med Rehabil. 2008 Oct;89(10):1863-72. doi: 10.1016/j.apmr.2008.03.013.


Objective: To compare outcomes between lower-extremity amputees who receive and do not receive acute postoperative inpatient rehabilitation within a large integrated health care delivery system.

Design: An observational study using multivariable propensity score risk adjustment to reduce treatment selection bias.

Setting: Data compiled from 9 administrative databases from Veterans Affairs Medical Centers.

Participants: A national cohort of veterans (N=2673) who underwent transtibial or transfemoral amputation between October 1, 2002, and September 30, 2004.

Interventions: Not applicable.

Main outcome measures: One-year cumulative survival, home discharge from the hospital, and prosthetic limb procurement within the first postoperative year.

Results: After reducing selection bias, patients who received acute postoperative inpatient rehabilitation compared to those with no evidence of inpatient rehabilitation had an increased likelihood of 1-year survival (odds ratio [OR]=1.51; 95% confidence interval [CI], 1.26-1.80) and home discharge (OR=2.58; 95% CI, 2.17-3.06). Prosthetic limb procurement did not differ significantly between groups.

Conclusions: The receipt of rehabilitation in the acute postoperative inpatient period was associated with a greater likelihood of 1-year survival and home discharge from the hospital. Results support early postoperative inpatient rehabilitation following amputation.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Amputation, Surgical / rehabilitation*
  • Amputees / rehabilitation*
  • Delivery of Health Care, Integrated / organization & administration*
  • Female
  • Femur / surgery
  • Humans
  • Inpatients
  • Leg / surgery*
  • Male
  • Middle Aged
  • Postoperative Care
  • Tibia / surgery
  • Treatment Outcome
  • United States
  • Veterans