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The Application Of The Lace+ Readmission And Mortality Prediction Tool For Lower Extremity Major Amputations: A Retrospective Cohort Study
Areeg A. Abu El Hawa, BS1, John D. Bovill, BS1, Joshua Mondshine, MS1, Jenna C. Bekeny, MD1, Kevin G. Kim, BS1, Cameron Akbari, MD2, Kenneth L. Fan, MD2, David H. Song, MD2, Christopher E. Attinger, MD2, Karen K. Evans, MD2.
1Georgetown University School of Medicine, Washington, DC, USA, 2MedStar Georgetown University Hospital, Washington, DC, USA.

PURPOSE: The Length of stay, Acuity of admission, Charlson Comorbidity Index (CCI) score, and Emergency department visit in the last 6 months Index (LACE Index) is a validated tool that has successful identified patients at risk for readmission. Given the high financial burden of chronic wounds and below-knee amputations (BKA), a reliable model to predict the poor postoperative outcomes is warranted. Therefore, this present study seeks to evaluate the utility of
of the LACE+ Index in predicting 30- and 90-day outcomes in patients undergoing below knee amputation.METHODS:A retrospective review of all patients that underwent BKA from 2013 and July 2020 was performed. Data collected included patient demographics, wound characteristics, comorbid conditions, operative characteristics, LACE+ score calculations. Outcomes of interest included 30- and 90-day readmission, reoperation, and mortality.

RESULTS: Three hundred sixty-two patients underwent below knee amputations were identified. The median age at time of surgery was 60.3 years (IQR 52.1, 68.9), the median body mass index was 27.8 kg/m2 (IQR 23.7, 32.5) and the mean CCI was 5.23 (SD 2.70). Median length of stay was 9 days (IQR 7, 15) and 30- and 90- day readmission rates were 7.7% (n=28) and 15.8% (n=57), respectively. Increased LACE+ score significantly predicted risk of 30- and 90-day readmission (OR 1.07, p=0.002; OR 1.09, p<0.001, respectively), both 30- and 90-day mortality, (OR 1.14, p=0.002; OR 1.15, p<0.001, respectively), and both 30- and 90-day risk of reoperation (OR 1.12, p<0.001; OR 1.12, p<0.001).
CONCLUSION: LACE+ Index was successful in predicting several postoperative outcomes - reoperation, readmission, and mortality rates - at both 30- and 90-days following below knee amputation. The findings of the present study demonstrate that patients with a higher LACE+ score are at an increased risk of adverse outcomes following discharge. Tools that accurately predict postoperative complications, especially in high-cost populations such as the chronic wound and amputation patient groups, will be increasingly valued and can aid in allocating health care services. Future prospective studies are needed to further investigate the utility of the LACE+ index to predict postoperative readmission, reoperation, and mortality.


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