Incidence of lower limb amputation in Australian hospitals from 2000 to 2010.

BACKGROUND: Contemporary literature reports that the incidence of lower limb amputation has declined in many countries. This impression may be misleading given that many publications only describe the incidence of lower limb amputations above the ankle and fail to include lower limb amputations below the ankle. OBJECTIVES: To describe trends in the incidence of different levels of lower limb amputation in Australian hospitals over a 10-year period. STUDY DESIGN: Descriptive. METHOD: Data describing the age-standardised incidence of lower limb amputation were calculated from the Australian National Hospital Morbidity database and analysed for trends over a 10-year period. RESULTS: The age-standardised incidence of lower limb amputation remained unchanged over time (p = 0.786). A significant increase in the incidence of partial foot amputations (p = 0.001) and a decline in the incidence of transfemoral (p = 0.00) and transtibial amputations (p = 0.00) were observed. There are now three lower limb amputations below the ankle for every lower limb amputation above the ankle. CONCLUSION: While the age-standardised incidence of all lower limb amputation has not changed, a shift in the proportion of lower limb amputations above the ankle and lower limb amputations below the ankle may be the result of improved management of precursor disease that makes partial foot amputation a more commonly utilised alternative to lower limb amputations above the ankle. Clinical relevance This article highlights that although the incidence of lower limb amputation has remained steady, the proportion of amputations above the ankle and below the ankle has changed dramatically over the last decade. This has implications for how we judge the success of efforts to reduce the incidence of lower limb amputation and the services required to meet the increasing proportion of persons with amputation below the ankle.

Stroke rehabilitation in Australia in a freestanding inpatient rehabilitation unit compared with a unit located in an acute care hospital.

OBJECTIVE: To study the functional outcome of stroke rehabilitation from 2 units that are similar in most aspects except for location: freestanding rehabilitation units (FSRU) versus acute care hospital (acute hospital rehabilitation unit [AHRU]). DESIGN: An observational retrospective cohort study. SETTING: Rehabilitation units in university-affiliated hospitals in Australia. METHODS: Five-year data on functional outcomes of stroke rehabilitation and rehabilitation process measures from an FSRU were compared with data from the subsequent 5 years after the same unit was relocated to an AHRU. MAIN OUTCOME MEASUREMENTS: Time from stroke onset to rehabilitation assessment, time to transfer to rehabilitation, length of stay (LOS), Functional Independence Measure (FIM) score, Motor Assessment Scale (MAS) score, transfer back to acute care, walking velocity, and discharge destination. RESULTS: Data on 357 patients from an FSRU and 372 patients from an AHRU who completed the rehabilitation program are presented. Baseline characteristics, such as age, gender, stroke location, stroke type, and risk factors, were similar in the 2 groups. There was no difference in outcomes such as FIM score, MAS score, walking velocity, or discharge destination. On regression analysis, the patients in an FSRU had a longer LOS (37.6 versus 35.9 days) and were more likely to be transferred to acute care than from an AHRU (12.4% versus 5.4%). The episode LOS (total LOS in acute and rehabilitation units) was nearly identical in the 2 settings at 52.6 days (15 in acute care + 37.6 days in an FSRU and 16.7 in acute care + 35.9 days in an AHRU). CONCLUSIONS: Stroke rehabilitation effectiveness is not related to the proximity of a rehabilitation facility to acute medical services. However, the increased need for the transfer of patients with medical complications from FSRU to acute care, longer LOS in an FSRU, and greater difficulty in obtaining consultations from other medical specialties persuade us to recommend a unit co-located with acute care services instead of an FSRU.

Do stroke patients with intracerebral hemorrhage have a better functional outcome than patients with cerebral infarction?

OBJECTIVE: To compare the functional outcome of stroke patients with cerebral infarction (CI) and intracerebral hemorrhage (ICH) after rehabilitation. DESIGN: Review of a prospectively maintained database of all stroke patients admitted to a rehabilitation unit during a 9.5-year period. SETTING: Rehabilitation unit in a university hospital in Australia. PATIENTS: A total of 718 consecutive stroke admissions (589 CI and 129 ICH) who met the inclusion criteria. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASUREMENTS: Functional Independence Measure (FIM) gain, FIM efficiency, Motor Assessment Scale (MAS) change, gait velocity, and discharge destination. RESULTS: Patients who had ICH were more severely disabled on admission compared with patients who had CI and achieved a greater functional improvement with rehabilitation, ie, a greater FIM efficiency and a greater MAS change. Admission FIM score, admission MAS score, and length of stay were significant explanatory variables for the discharge FIM and FIM gain in both ICH and CI patients. On general linear model analyses, stroke type remained a significant explanatory factor for FIM gain, after adjusting for admission FIM, length of stay, age, and days from stroke onset to rehabilitation admission, ie, stroke patients with ICH obtained a better functional outcome than patients with CI. Admission motor FIM, admission MAS, younger age, and increasing length of stay were independent predictors for FIM gain and discharge FIM for both CI and ICH groups. Admission cognitive FIM score predicted discharge FIM for both the CI and ICH groups and FIM gain in the ICH group but was not a predictor of FIM gain for the CI group. The majority of patients in both groups went home at discharge. CONCLUSIONS: Although patients with ICH had a greater level of disability on admission to rehabilitation, they achieved significantly greater gains in function than patients with CI after rehabilitation. This was found regardless of the severity of disability on admission.