Journal of NeuroEngineering and Rehabilitation

found that mortality rates were significantly higher (21.9% vs 12.1%) in military amputees than in able-bodied controls [ 30 ] . Cardiovascular disease mortality was twice as likely in amputees compared to controls and was cited as the main cause for this difference. Our study differs from the findings reported by Modan (1998), since the adjusted cardiac mor- tality risk in the patients with TFA due to trauma or cancer did not differ from controls. Although they did not further analyze specific causes of mortality within cardiovascular dis- ease, they reported a trend towards an increase in the risk of myocardial infarction among the amputees. This is similar to our finding that those with TFA due to trauma or cancer were more likely to have a myocardial infarction when com- pared to able-bodied controls. Several studies have revealed that only about a quarter of individuals with transfemoral amputations receive a prosthesis [ 31 – 34 ] A 10-year increase in age in the civilian population has been shown to result in a 54% decrease in the likelihood of being fit for a prosthesis [ 35 ] . Similarly, a study of elderly US veterans revealed that a 10-year age in- crease reduced the likelihood of receiving a prosthesis by 78% [ 36 ] . Relatedly, the odds of receiving a prosthesis were almost 30 times higher in those able to walk inde- pendently prior to an amputation relative to those who could not walk independently [ 35 ] . Interestingly, time elapsed between surgery and the prosthesis decision was associated with a rise in the probability of receiving a prosthesis for the first 3 months after the amputation [ 35 ] . These data as a whole illustrate the lack of consistent, reliable prosthesis prescriptions and treatment, and the unnecessary variability of care that patients with limb loss currently receive. While the data in this study appeared to show that receipt of a prosthesis was correlated with a decreased mortality risk from non-cardiac events, this was likely due to the fact that to receive a prosthesis, one had to live for some time following a TFA and therefore it is unlikely due to a protective effect from the prosthesis. Due to limita- tions in the data, it was difficult to account for this endogeneity. Notably, receipt of a prosthesis does not appear to be associated with a reduced risk of a major cardiac event following amputation. Fig. 2 Time dependent probability of a major cardiovascular event (MACE) or death for individuals with a transfemoral amputation due to trauma or cancer compared to matched control subjects without an amputation Mundell et al. Journal of NeuroEngineering and Rehabilitation 2018, 15 (Suppl 1):58 Page 7 of 72