Patterns of inpatient acute care and emergency department utilization within one year post-initial amputation among individuals with dysvascular major lower extremity amputation in Ontario, Canada: A population-based retrospective cohort study

• Published in: PloS one 2024-07, Vol.19 (7), p.e0305381
• Main Authors: Guilcher, Sara J T, Mayo, Amanda L, Swayze, Sarah, de Mestral, Charles, Viana, Ricardo, Payne, Michael W, Dilkas, Steven, Devlin, Michael, MacKay, Crystal, Kayssi, Ahmed, Hitzig, Sander L
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Ambulatory care; Amputation; Amputation, Surgical - statistics & numerical data; Asthma; Biology and Life Sciences; Canada Health Act; Cancer; Chronic obstructive pulmonary disease; Codes; Comorbidity; Congenital diseases; Datasets; Dementia; Design factors; Diabetes; Emergency medical care; Emergency medical services; Emergency procedures; Emergency service; Emergency Service, Hospital - statistics & numerical data; Female; Health care; Health insurance; Heart failure; Hospitalization - statistics & numerical data; Hospitals; Humans; Hypertension; Inpatients - statistics & numerical data; Long term health care; Lower Extremity - surgery; Male; Medical care; Medicine and Health Sciences; Mental disorders; Mental health; Middle Aged; Mortality; Neighborhoods; Ontario - epidemiology; Patient Acceptance of Health Care - statistics & numerical data; Patient Readmission - statistics & numerical data; People and places; Population; Population studies; Prescription drug plans; Prescription drugs; Retrospective Studies; Rheumatoid arthritis; Risk Factors; Sex differences; Type 2 diabetes; Utilization
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0305381

Lower extremity amputation (LEA) is a life altering procedure, with significant negative impacts to patients, care partners, and the overall health system. There are gaps in knowledge with respect to patterns of healthcare utilization following LEA due to dysvascular etiology. To examine inpatient acute and emergency department (ED) healthcare utilization among an incident cohort of individuals with major dysvascular LEA 1 year post-initial amputation; and to identify factors associated with acute care readmissions and ED visits. Retrospective cohort study using population-level administrative data. Ontario, Canada. Adults individuals (18 years or older) with a major dysvascular LEA between April 1, 2004 and March 31, 2018. Not applicable. Acute care hospitalizations and ED visits within one year post-initial discharge. A total of 10,905 individuals with major dysvascular LEA were identified (67.7% male). There were 14,363 acute hospitalizations and 19,660 ED visits within one year post-discharge from initial amputation acute stay. The highest common risk factors across all the models included age of 65 years or older (versus less than 65 years), high comorbidity (versus low), and low and moderate continuity of care (versus high). Sex differences were identified for risk factors for hospitalizations, with differences in the types of comorbidities increasing risk and geographical setting. Persons with LEA were generally more at risk for acute hospitalizations and ED visits if higher comorbidity and lower continuity of care. Clinical care efforts might focus on improving transitions from the acute setting such as coordinated and integrated care for sub-populations with LEA who are more at risk.