This article was originally published here
PM R. 2021 Aug 1. doi: 10.1002/pmrj.12682. Online ahead of print.
INTRODUCTION: The choice of incident amputation level can have a profound effect on clinical outcomes. Amputations at the transmetatarsal (TM) or transtibial (TT) levels result in greater preservation of function and mobility, while transfemoral (TF) amputations, typically result in a greater adverse impact. Prior investigations have explored racial/ethnic and regional variation in incident amputation level. This study overcomes some of the methodological limitations seen in prior research through the use of a large national, multi-year Veteran sample, and by including only those who have undergone an incident amputation.
OBJECTIVES: Determine if there are national/regional differences in the frequency of incident TF amputation compared with TM and TT amputation. Determine if race/ethnicity and geographic region is associated with incident TF amputation level. Determine if racial/ethnic disparities of incident TF amputation differ by the presence of diabetes or prior revascularization.
DESIGN: Retrospective cohort study of Veterans undergoing an incident dysvascular lower extremity amputation (LEA).
SETTING: 110 VA Medical Centers.
PARTICIPANTS: 7296 Veterans undergoing incident unilateral dysvascular LEA identified in the Veterans Affairs Surgical Quality Improvement Program (VASQIP) database (2005-2014).
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURE: Incident amputation level.
RESULTS: The White, Black, and Hispanic risk for an incident TF amputation was 31% (n = 1356), 35% (n = 810), and 46% (n = 293), respectively. In the Continental region, Blacks who had not had a prior revascularization were more likely to undergo a TF amputation compared to Whites both with and without diabetes (OR = 1.4; 95% CI, 1.1, 1.9 and OR = 1.5; 95% CI, 1.1, 2.1, respectively). In the Southeast region, Hispanics compared with Whites were at increased odds of undergoing a TF amputation, irrespective of a diabetes or a prior revascularization (ORs > =2.9).
CONCLUSIONS: Racial and ethnic disparities exist in choice of proximal compared with distal amputation in specific VA geographic regions. This article is protected by copyright. All rights reserved.