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.