Back to 2016 Annual Symposium ePosters

Objectives
The practice of prosthetics is a fragmented industry that focuses primarily on delivery of product rather than outcomes. Surgeons that perform amputations have little experience in the prosthetics field and have limited ability to influence rehabilitation-based outcomes. Modern advances in the fields of amputation and prosthetics require the integration of the prosthetist and the surgeon to achieve the most favorable outcomes. We therefore undertook a study to compare traditional care (TC) verses an integrated care model (IC).
Methods
Patients who underwent BKA between January 1, 2009-December 31, 2012 were identified in 3 separate practices that use either a TC model or an IC model where rehabilitation/prosthetics is integrated into the surgeon’s practice. We successfully recruited 148 patients. 52 participated in a phone survey targeted at assessing QOL post amputation. Age difference was assessed using independent sample t-test. All other patient demographics and QOL assessments were compared using Pearson Chi Squared Test. Survival was assessed using Kaplan Meier analysis.
Results

Demographics

	Integrated Care	Traditional Care
	N = 107	N = 41	P value
Gender			0.897
Male	64 (59.8%)	25 (61.0%)
Female	43 (40.2%)	16 (39.0%)
Ave age at surgery	63.4	71.5	0.002
Patients with:
Tobacco use	44 (41.1%)	25 (61.0%)	0.017
Diabetes	68 (63.6%)	36 (87.8%)	0.009

Survival following surgery was significantly improved for patients treated by the IC model (p=0.001). Stratifying by age revealed that patients = 65 experienced improved survival when treated by the IC model (p=0.005). Survival 6 months after surgery was similar in both care models for patients >=65 at the time of surgery, however, at 1 year following surgery a survival advantage begins to emerge for patients treated with the IC model (p=0.09). QOL data seems to indicate the patients in the IC model (n=42) were statistically happier with their care, but the limited response in the TC group (n=9) makes the statistics underpowered. There was no difference in prosthetics use, ambulatory status or Houghton scores between the IC and TC groups.
Conclusion:
Results of this study suggest that patients >=65 have a distinct survival advantage when treated by the IC model over the TC model. This does not become evident until more than 1 year after surgery. Future studies will be aimed at verifying these observations in a larger cohort and exploration of the root cause of the survival advantage identified in this study.