Authors (including presenting author) :
Chu CKG(1), Hung LPJ(2), Chan CH(1), Wong SM(1)
Affiliation :
(1)Prosthetics and Orthotics Department, Kowloon East Cluster, (2)Department of Orthopaedics & Traumatology, Tseung Kwan O Hospital
Introduction :
Transtibial amputation and subsequent prosthesis fitting can cause prolonged hospital length of stay (LOS) and rehabilitation that greatly increases hospital operational cost. The traditional pathway to treat new amputees under care by Hospital Authority usually involves in same episode of admission which usually takes months to remain as inpatient until the first prosthesis is fitted. Recently, Department of Orthopaedics & Traumatology of Tseung Kwan O Hospital (TKOH) collaborating with the Prosthetic and Orthotic Department of Kowloon East Cluster (KEC) had introduced a 2-staged admission pathway for new unilateral transtibial amputees in order to shorten hospital LOS as well as to achieve similar level of treatment outcomes. The 2-staged admission pathway includes: 1. discharging amputee once medically fit and walking independently with aids, 2. on-going monitoring of discharged amputee and prosthesis fitting in outpatient clinics, and 3. readmission for prosthetic training.
Objectives :
The aim of this study is to compare the difference of LOS between the traditional pathway and the 2-staged admission pathway of new unilateral transtibial amputation.
Methodology :
A retrospective cohort study was done from March 2014 to September 2018 in KEC. Fourteen new unilateral transtibial amputees (7 male and 7 female) with the mean age of 57.5±11.2 were recruited. Subjects were divided into two groups: first prosthetic fitting within same episode of admission versus first prosthesis fitting in two admissions. Independent t-test was performed to compare the difference of LOS between the two groups. P value of < 0.05 was considered statistically significant.
Result & Outcome :
The mean LOS upon first discharge was significantly reduced (p<0.05) in 2-staged admission by 52.9 days when compared with same admission. The mean total hospital LOS including prosthetic training was also significantly reduced (p<0.05) by 43.3 days.
Concerning treatment outcomes, although K level after one month of use of prosthesis was similar in the two groups, more patients in 2-staged admission were able to walk without aids and perform daily walking for more than 2 hours. Moreover, complication of sore within three months was less frequent in 2-staged admission.
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