Trends in rehabilitation after amputation for geriatric patients with vascular disease: Implications for future health resource allocation

Objective: To assess the effect of demographic changes on rehabilitation of geriatric patients after amputation and the implications for future health resource allocation. Design: Population-based study. Setting: Olmsted County, MN. Participants: Residents over the age of 65 years who had a major lower-extremity amputation because of peripheral arterial disease between 1956 and 1995. Patients who had amputations between 1956 and 1973 (earlier cohort) were compared with those who had amputations between 1974 and 1995 (later cohort). Interventions: Not applicable. Main Outcome Measures: Demographic and clinical features, total number of amputations, amputation rates, and rate of successful prosthetic fitting over time. cl-Results: Of 292 patients, 93 had amputations between 1956 and 1973 and 199 between 1974 and 1995. Amputation rates declined after 1985, but the total number of amputations was unchanged. Patients in the later cohort were more likely to have a below-knee amputation (P<.001) and cerebrovascular disease (P=.008) and to be discharged to a nursing home (P<.001). There was no significant difference in median age at amputation, survival, or rates of successful prosthetic fitting over time. Conclusion: Although amputation rates have declined, the total number of amputations has increased. The rate of successful prosthetic fitting in the geriatric population has not changed significantly over 40 years. Amputations in the geriatric population in the United States will probably double from 28, 000 to 58, 000 per year by 2030, requiring considerable resources.