The Role of Earlier Receipt of a Lower Limb Prosthesis on Emergency Department Utilization.

INTRODUCTION Adverse events after a lower limb amputation (LLA) can negatively affect the rehabilitation process and may lead to emergency department (ED) visits. Earlier receipt of a prosthesis, as compared to delayed or not receiving a prosthesis, may decrease or moderate the risk of increased ED utilization. Additionally, adverse events (i.e. fall-related injury) may be associated with increased healthcare utilization as measured by ED use. Implication of timing of prosthesis provision after amputation and reduced ED use is not well established. Obtaining data about ED utilization early post-LLA could assist the rehabilitation team to ensure timely and appropriate access to improve outcomes. OBJECTIVE To determine the role timing of prosthesis receipt has in ED utilization and the association of fall/FRI with healthcare utilization. DESIGN Retrospective observational cohort using commercial claims data. A logistic regression model was used to assess factors that influence ED utilization post-LLA. SETTING Watson/Truven administrative database 2014-2016. PARTICIPANTS The study sample consisted of 510 adults age 18-64 with continuous enrollment for three years. INTERVENTIONS Independent variables included age, sex, diabetes status, amputation level, fall diagnosis, and prosthesis receipt. Fall was defined as presence of diagnosis code in any outpatient procedure after the amputation date. MAIN OUTCOME MEASURE ED use after amputation was defined as the presence of procedure codes that billed for ED services (99281 - 99285). RESULTS Individuals who receive a prosthesis early, within 0 to 3 months, post-LLA were 48% (OR=0.52 95% CI: 0.28 - 0.97) less likely to use the ED compared to those who did not receive a prosthesis. Individuals who experienced a fall/FRI had 2.8 (OR=2.86 95% CI: [1.23-6.66]) times the odds of ED utilization. CONCLUSION Receipt of a prosthesis reduces the risk of ED use. The current study underscores the value of prostheses during the rehabilitation process after LLA. This article is protected by copyright. All rights reserved.