Geographical socioeconomic disadvantage is associated with adverse outcomes following major amputation in diabetic patients

J Vasc Surg. 2021 Oct;74(4):1317-1326.e1. doi: 10.1016/j.jvs.2021.03.033. Epub 2021 Apr 15.

Abstract

Objective: Socioeconomic disadvantage is a known predictor of adverse outcomes and amputation in patients with diabetes. However, its association with outcomes after major amputation has not been described. Here, we aimed to determine the association of geographic socioeconomic disadvantage with 30-day readmission and 1-year reamputation rates among patients with diabetes undergoing major amputation.

Methods: Patients from the Maryland Health Services Cost Review Commission Database who underwent major lower extremity amputation with a concurrent diagnosis of diabetes mellitus between 2015 and 2017 were stratified by socioeconomic disadvantage as determined by the area deprivation index (ADI) (ADI1 [least deprived] to ADI4 [most deprived]). The primary outcomes were rates of 30-day readmission and 1-year reamputation, evaluated using multivariable logistic regression models and Kaplan-Meier survival analyses.

Results: A total of 910 patients were evaluated (66.0% male, 49.2% Black), including 30.9% ADI1 (least deprived), 28.6% ADI2, 19.1% ADI3, and 21.2% ADI4 (most deprived). After adjusting for differences in baseline demographic and clinical factors, the odds of 30-day readmission was similar among ADI groups (P > .05 for all). Independent predictors of 30-day readmission included female sex (odds ratio [OR], 1.45), Medicare insurance (vs private insurance; OR, 1.76), and peripheral artery disease (OR, 1.49) (P < .05 for all). The odds of 1-year reamputation was significantly greater among ADI4 (vs ADI1; OR, 1.74), those with a readmission for stump complication or infection/sepsis (OR, 2.65), and those with CHF (OR, 1.53) or PAD (OR, 1.59) (P < .05 for all).

Conclusions: Geographic socioeconomic disadvantage is independently associated with 1-year reamputation, but not 30-day readmission, among Maryland patients undergoing a major amputation for diabetes. A directed approach at improving postoperative management of chronic disease progression in socioeconomically deprived patients may be beneficial to reducing long-term morbidity in this high-risk group.

Keywords: Area deprivation index; Diabetes; Major amputation; Readmission; Reamputation.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Amputation / adverse effects*
  • Databases, Factual
  • Diabetic Foot / diagnosis
  • Diabetic Foot / epidemiology
  • Diabetic Foot / surgery*
  • Female
  • Humans
  • Male
  • Maryland / epidemiology
  • Middle Aged
  • Neighborhood Characteristics
  • Patient Readmission
  • Reoperation
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Social Deprivation*
  • Social Determinants of Health*
  • Socioeconomic Factors*
  • Time Factors
  • Treatment Outcome
  • Vulnerable Populations
  • Young Adult