SLR - October 2015 - Zachary Criswell

Rates and Predictors of Readmission after Minor Lower Extremity Amputations

Reference: Beaulieu RJ, Grimm JC, Lyu H, Abularrage CJ, Perler BA. Rates and Predictors of Readmission After Minor Lower Extremity Amputations. J Vasc Surg. 2015 Jul; 62(1): 101-105.

Reviewed By: Zachary Criswell, DPM
Residency Program: University Hospital, Newark, NJ

Podiatric Relevance: Minor lower extremity amputations, defined as transmetatarsal or digital amputations, are common podiatric procedures and are an unfortunate consequence of diabetes mellitus. Many hospitalized patients who undergo these pedal amputations have post-operative complications that necessitate unplanned readmission after discharge, which poses a financial burden on third payer parties and hospitals themselves. Many of these patients who are readmitted after minor amputations, ultimately undergo a more proximal limb amputation, such as a BKA or AKA. Recent changes in healthcare reform laws, most notably the Patient Protection and Affordable Care Act, seek to decrease the rate of unplanned readmissions by posing financial penalties on treating physicians. The goal of this study was to examine the incidence of unplanned readmission after minor amputations and to define any modifiable patient factors that could be associated with high admission rates.

Methods: Retrospective review of patient medical and billing records that underwent minor amputations at Johns Hopkins Hospital from January 2000 through July 2012

Results: Of the 717 patients who underwent minor amputations, readmission occurred in 13.9 percent of them; 3.9 percent were readmitted within 30 days of discharge. The most common reasons for readmission included: infection (49 percent), ischemia (29 percent), non-healing wounds (19 percent), and indeterminate (4 percent). When looking at patient demographics and past medical histories, certain co-morbidities, most notably peripheral arterial disease and chronic renal insufficiency, were highly associated with readmission.

Conclusions: This study helped to define certain patient factors, many of them unmodifiable, that are associated with early readmission after minor pedal amputations. While every endeavor should be made to prevent early readmission, it is a fact that a vast majority of these patients have many co-morbidities and systemic diseases that are very arduous to manage. More proximal limb amputations in these patients are almost inevitable. However, imposing penalties on treating surgeons would in theory sway a lot of them to simply perform a proximal limb amputation as the index surgery (as these are associated with better healing rates) rather than attempting limb salvage by trying to preserve as much of the foot as possible. 

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