Short- and Long-Term Prognosis among Veterans with Neurological Disorders and Subsequent Lower-Extremity Amputation

Neuroepidemiology, 2009 · DOI: 10.1159/000170085 · Published: November 8, 2008

Simple Explanation

This study looks at how having neurological problems affects how well veterans do after getting part of their leg cut off. The study checked if different nerve problems made it more likely for them to die soon after surgery or within a year. The research found that many veterans who needed leg amputations already had nerve issues, like problems with their spinal cord or other nerve disorders. Those with spinal cord or peripheral nerve issues surprisingly did better than others. The study highlights how varied this group of patients is and suggests we need to understand them better. It seems having problems with the central nervous system makes things tougher for these patients.

Study Duration

2 Years

Participants

4,720 United States veterans with LE amputations

Evidence Level

Cohort study

Key Findings

1
43.3% of the 4,720 patients had neurological disorders documented prior to amputation.
2
Patients with a PNS disorder or spinal cord injury were significantly less likely to die in hospital and within 1 year when compared to the other types of neurological condition groups.
3
Significant predictors of both death in hospital and death at 1 year were older age, transfemoral amputation, systemic sepsis etiology, and comorbid arrhythmia, renal failure, and fluid and electrolyte disturbances.

Research Summary

This study examined both short- and long-term mortality in a 2-year cohort of veterans with preexisting neurological disorders and subsequent LE amputation in a large integrated US health system. Almost 50% of the amputees had a coexisting neurological disorder. Health status prior to amputation was poorer for those with preexisting neurological conditions compared to those without. The high prevalence of preexisting neurological disorders among LE amputees and the varying effect of different conditions on risk of mortality highlights the diverseness of this understudied population.

Practical Implications

Targeted Interventions

Develop targeted interventions for LE amputees with CNS disorders to improve survival rates.

Resource Allocation

Allocate healthcare resources to address comorbidities like arrhythmia, renal failure, and electrolyte disturbances.

Rehabilitation Focus

Emphasize acute rehabilitation to improve survival odds, particularly for those with compromising preexisting conditions.

Study Limitations

1
A documentation of race was not available for the entire sample and thus was not examined.
2
Veterans are predominately male, and it is unknown if findings can be generalized to females.
3
Studying outcomes following VHA care may not be generalizable to private sector studies.

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