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611 - Amputee rehabilitation and palliative care consultations for inpatients undergoing initial major dysvascular lower limb amputation

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

JD

Jennifer Dens Higano, MD

Resident Physician
Mayo Clinic Department of Physical Medicine and Rehabilitation
Rochester, Minnesota, United States

Co-Author(s)

RL

Ryan Lewis, MBBS

Fellow, Palliative Care
Mayo Clinic Rochester
Rochester, Minnesota, United States
TB

Toure Barksdale, MD

Clinical Instructor of Physical Medicine & Rehabilitation, Attending Physician
Mayo Clinic
Rochester, Minnesota, United States
CS

Clay C. Smither, MD

Chair, Assistant Professor
Mayo Clinic Department of Physical Medicine and Rehabilitation
Rochester, Minnesota, United States

Objectives: Major lower limb amputations due to dysvascular disease are associated with significant mortality, with 30-day mortality rates around 15% and one-year rates exceeding 30%. This study aims to assess the frequency of inpatient consultations for amputee rehabilitation and palliative care among patients undergoing their first major lower limb amputation due to dysvascular conditions.

Design: We identified adult patients who underwent transmetatarsal, transtibial, or transfemoral amputations from June 2018 to June 2022 at a single center (n=633) using electronic medical records. We included only those with initial lower limb amputations resulting from dysvascular causes, such as peripheral artery disease or diabetes mellitus. Patients with prior amputations or non-dysvascular causes were excluded. After excluding 186 patients, 447 individuals remained. We reviewed their records to determine if they received inpatient amputee rehabilitation and/or palliative care consultations during their associated hospitalization.

Results: Among the 447 patients, 401 (89.7%) received either amputee rehabilitation or palliative care consultations. Specifically, 384 patients (85.9%) had amputee rehabilitation consultations, 97 patients (21.7%) had palliative care consultations, and 80 patients (17.9%) had both consultations. Conversely, 46 patients (10.3%) received neither type of consultation during their hospitalization.

Conclusions: Major lower limb amputations highlight significant rehabilitation and palliative needs. The majority of patients received amputee rehabilitation consultations, with fewer receiving palliative care consultations. This disparity underscores the need for further research to understand the underlying reasons and to improve quality of care by potentially increasing or better targeting consultations for amputee rehabilitation and palliative care in hospitalized patients.