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Scholarly Commons > HCA Healthcare Journal > Vol. 7 > Iss. 1 (2026)

 

Keywords

inpatient rehabilitation; rehabilitation centers; amputation, surgical; activities of daily living; transfemoral amputation; transtibial amputation; outcomes; opioid analgesics; home discharge; retrospective studies

Disciplines

Rehabilitation and Therapy

Abstract

Background

Lower limb amputations significantly impair the mobility and activities of daily living (ADLs) and frequently require inpatient rehabilitation with opioid analgesics to control pain. Large-scale studies of clinical characteristics specific to rehabilitation outcomes after lower limb amputations are limited in the current literature. Identifying the associations between specific clinical characteristics and opioid analgesic use with home versus non-home discharge can help improve care for patients undergoing inpatient rehabilitation after lower-limb amputations.

Methods

In this retrospective study, we examined 1611 patients from 58 inpatient rehabilitation units who underwent transfemoral or transtibial amputations between January 2021 and December 2022, identified using International Classification of Diseases (ICD) codes. Multivariable logistic regression was used to identify patient characteristics, including opioid use, associated with home discharge after inpatient rehabilitation for lower-limb amputation.

Results

There were 1124 (69.8%) patients with transtibial amputations and 487 (30.2%) patients with transfemoral amputations. When compared with transtibial amputees, opioids were used more frequently (86.5% vs 82.1%, P = .032) and at higher oral morphine milligram equivalents (356 mg vs 241 mg, P = .019) at admission among transfemoral amputees. A total of 1223 patients (75.9%) were discharged home after inpatient rehabilitation. Patient characteristics independently associated with a lower likelihood of home discharge included a higher medical comorbidity index, adverse events during inpatient rehabilitation, intravenous (IV) opioid use at admission, and lower initial functional levels.

Conclusion

Early identification of patients with clinical characteristics associated with a lower likelihood of returning home may facilitate the development of targeted rehabilitation strategies during inpatient rehabilitation.

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