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Impact Of Patient Age On Quality Of Life And Prosthesis Satisfaction Following Major Lower Extremity Amputation
Samantha L. Terranella, MD, Alexandra Mao, Todd Castleberry, PhD, Patsy Diaz Delgado, MS, Yazan Duwayri, MD, Olamide Alabi.
Emory University, Atlanta, GA, USA.
Background: Nontraumatic lower extremity major amputation (LEA) has a profound impact on an individual’s functional mobility and longevity. There has been little focus on well-being (quality of life [QoL] or satisfaction) following LEA in patients receiving prosthesis care. This study aimed to assess the impact of age on well-being following LEA.
Methods: A cohort of patients who underwent LEA at two academic institutions between 2015-2019 was evaluated using the well-being subsection of the Prosthesis Evaluation Questionnaire (PEQ-WB). This analysis included patients who were fitted with a prosthesis through an institutional vendor contract, aiming to assess optimal patient well-being using QoL (score ≥8) and satisfaction (score ≥7) subcores. The primary exposure was age (<50yo, ≥50yo). The primary outcomes of interest were well-being subscores of satisfaction and QoL following LEA and prosthetic fitting, and the secondary outcome was satisfaction and QoL over time.
Results: Among 73 patients who underwent LEA, the median age was 58 ± 20, 31.5% were under age 50yo, 71.2% were male, 63.0% were Black. Patients under age 50 less often had diagnoses of peripheral arterial disease, diabetes mellitus, hypertension, chronic kidney disease, or lifetime tobacco use. There were no statistical differences in above or below knee amputations. The indication for LEA was largely ischemia/gangrene (50.7%, n=37). A higher proportion of patients over 50yo reported less than optimal QoL scores compared to patients <50yo (58% vs 34.8%, p=.03) (
Table 1). A higher proportion of patients <50yo reported higher satisfaction scores, however, these did not reach statistical significance. Follow-up questionnaires were completed by 49.3% (n=36) of the cohort. There were no significant differences between age groups in improvement in QoL or satisfaction scores over time (
Table 1).
Conclusions:Older individuals who undergo LEA and are fitted for prosthesis report poorer QoL while younger individuals report higher satisfaction and QoL. Further exploration of healthcare utilization and process improvement toward improved well-being in LEA individuals with prosthesis, particularly those of older age, are needed.
Table 1. Quality of Life and Satisfaction scores after Nontraumatic Major Lower Extremity Amputation, by age
| | | | |
| Overall | Age >50 years | Age <50 years | P value |
| QoL Scores | n = 73 | n = 50 | n = 23 | 0.03 |
| QoL >8 | 49.3% (36) | 42.0% (21) | 65.2% (15) | |
| QoL <8 | 50.7% (37) | 58.0% (29) | 34.8% (8) | |
| Satisfaction Scores | | | | 0.19 |
| Satisfaction ≥ 7 | 53.4% (39) | 50.0% (25) | 60.9% (14) | |
| Satisfaction < 7 | 46.6% (34) | 50.0% (25) | 39.1% (9) | |
| Change in QoL Scores | n = 36 | n =24 | n = 12 | 0.18 |
| Improvement | 36.1% (13) | 41.7% (10) | 25.0% (3) | |
| No Improvement | 63.9% (23) | 58.3% (14) | 75.0% (9) | |
| Change in Satisfaction Scores | | | | 0.33 |
| Improvement | 38.9% (14) | 41.7% (10) | 33.3 % (4) | |
| No Improvement | 61.1% (22) | 58.3% (14) | 66.7 % (8) | |
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