Background: Timely prosthesis acquisition is critical for optimizing functional recovery, reducing healthcare costs, and improving quality of life following major lower extremity amputation. However, delays in prosthesis acquisition remain poorly understood. This study aimed to evaluate the factors contributing to delays and disparities in prosthesis acquisition at a single academic institution. Methods: A retrospective chart review was conducted for 623 patients who underwent major lower extremity amputations between January 2014 and April 2022 at a quaternary referral center. Exclusion criteria included patients under 18 years, those with concurrent amputations, and patients deceased within one year of surgery. Patient demographics, surgical details, insurance types, and prosthesis acquisition timelines were analyzed using Kaplan-Meier survival estimates and multivariable regression. The primary outcomes were prosthesis acquisition and time to acquisition. Results: Only 52.8% of patients acquired a prosthesis, with a median time to acquisition of 142 days. Amputations performed by vascular surgeons were associated with the longest delays (158 days, p < 0.001), while those performed by orthopedic and plastic surgeons had shorter acquisition times (136 and 128 days, respectively). Below-knee amputations (BKA) and Medicaid insurance were linked to faster acquisition compared to above-knee amputations. System-level barriers, including insurance pre-approvals and transportation challenges, contributed to prolonged delays. Conclusions: Surgical subspecialty of the performing surgeon, amputation type, and other systemic factors impact prosthesis acquisition following major lower extremity amputation. Multidisciplinary care models and targeted interventions are needed to address these delays and improve equitable access to prosthetic rehabilitation.
Levy et al. (Tue,) studied this question.