Sex disparities in level of amputation

Abstract

Objective: To determine whether there is a sex-related disparity in the management of lower-extremity ischemia by evaluating the relationship between sex and level of nontraumatic amputation.

Design: This is a retrospective secondary analysis of community hospital data from the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample for 2007. Level of amputation was determined from International Classification of Diseases-9th Revision-Clinical Modifications procedure and coded as either transfemoral or transtibial. The main predictor was sex; covariates including age, race, income, insurance status, and presence of vascular disease were incorporated as control variables in regression analysis.

Setting: Nonfederal, short-term U.S. community hospitals.

Participants: Persons discharged from hospitals with a nontraumatic transtibial or transfemoral amputation (N=11,114).

Interventions: Not applicable.

Main outcome measures: Level of limb loss.

Results: A significant association was found between female sex and transfemoral amputation in both the bivariable (χ²=187.0; P<.000) and multivariable analysis (odds ratio [OR]=1.4; 95% confidence interval [CI]=1.3-1.5). Other covariates significant for influencing level of amputation during multivariable analysis include age, with highest age greater than 78 years at highest risk (OR=3.0; 95% CI, 2.6-3.5); 0-25% quartile of income or annual income less than $36,000 (OR=1.3; 95% CI, 1.1-1.5); Medicare insurance (OR=1.4; 95% CI, 1.1-1.6); Medicaid insurance (OR=1.3; 95% CI, 1.3-1.6); and cerebrovascular disease (OR=2.0; 95% CI, 1.7-2.4).

Conclusions: Female sex is significantly associated with transfemoral amputation compared with male sex. Transfemoral amputation has significant consequences, and further evaluation of preventative care and screening for women with vascular disease should be considered.