Association between Orthotic Intervention and Reamputation after Minor Lower Extremity Amputation in Patients with Vascular or Systemic Disease: A Nationwide Administrative Database Study in Japan.
retrospective_cohort · Level III
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- Record sourced from PubMed, PMID 40976547.
- Also identified by DOI 10.1016/j.apmr.2025.09.005.
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Abstract
To investigate the association between orthotic intervention and reamputation in patients after minor lower extremity amputation (LEA) using a Japanese national inpatient database. Retrospective cohort study. Acute hospital care PARTICIPANTS: A total of 6,667 patients who underwent minor LEA from July 2010 to March 2023 were identified using the Diagnosis Procedure Combination database. Eligible patients were categorized into those with and without orthotic intervention during hospitalization. Orthotic intervention included adapted footwear, non-removable offloading devices, prefabricated removable walking braces, and patellar-tendon-bearing orthoses, during hospitalization. The primary outcome was subsequent major ipsilateral LEA after discharge, while secondary outcomes included contralateral LEA and post-discharge mortality. Outcomes were compared between groups using stabilized inverse probability of treatment weighting based on propensity scores. Of 6,667 eligible patients, 581 received orthotic intervention. Stabilized inverse probability of treatment weighting analysis showed that orthotic intervention was associated with lower proportions of ipsilateral LEA (0.6% vs. 2.3%; risk difference [RD], -1.6%; 95% confidence interval [CI], -2.4 to -0.7), below-knee LEAs (0.4% vs. 1.9%; RD, -1.4%; 95% CI, -2.1 to -0.7), and mortality (3.6% vs. 5.6%; RD, -2.0%; 95% CI, -4.0 to -0.1). No significant differences were observed in the proportions of above-knee or contralateral LEAs. Orthotic intervention associated with reduced subsequent ipsilateral LEA and post-discharge mortality. However, due to the inherent limitations of the administrative database, including unavailable data on orthotic device types, actual usage, patient adherence, and precise amputation levels, these findings should be interpreted as associations.