From Fragmented Pathways to Value-Based Care: Aligning Amputation Rehabilitation Within the Health Sector Transformation Program

Abstract

Limb loss is a major cause of long-term disability worldwide and represents a growing systems-level challenge in Saudi Arabia, where diabetes and peripheral vascular disease account for a large proportion of extremity amputations. Our prior analysis of acquired upper and lower extremity amputations at a tertiary centre demonstrated the predominance of vascular-related lower limb loss and the concentration of complex cases in urban referral hospitals. Although surgical pathways are relatively established, rehabilitation trajectories remain less standardized and insufficiently integrated into perioperative care. Under the Health Sector Transformation Program, healthcare performance is increasingly measured by value, integration, equity, and functional outcomes rather than procedural volume alone.

Systemic gaps limit optimal recovery following amputation. Rehabilitation referral is not uniformly protocolized, early physiatry involvement may be delayed, and automatic referral triggers are often absent. Discharge planning inconsistently incorporates structured functional goals and prosthetic readiness timelines. Geographic disparities in rehabilitation infrastructure and specialist workforce distribution further restrict access to care. Fragmentation across perioperative, post-acute, and outpatient settings disrupts continuity, delays prosthetic fitting, increases preventable complications, and contributes to avoidable functional decline.

Addressing these challenges requires system-level transmutation aligned with value-based healthcare principles. Standardized national referral protocols, mandated early physiatry engagement, integrated amputation care pathways, strengthened regional rehabilitation networks, and national outcome tracking systems are essential. Positioning rehabilitation as a foundational component of the amputation continuum rather than an adjunct service will enhance equity, accountability, and long-term functional outcomes.