The Effect of Socioeconomic Status On Amputation Outcomes And Limb Salvage Interventions

Abstract

INTRODUCTION AND OBJECTIVES Disadvantaged patients have historically undergone higher level amputations without prior limb salvage interventions when compared with other populations. We sought to determine if racial and socioeconomic status is associated with decreased access to vascular care, less attempts of primary revascularization and higher level amputations. METHODS The Vascular Quality Initiative was queried from 2012-2020 for patients with below-knee and above-knee amputations (AKA). Outcomes based on race and distressed community index (DCI) as a marker of socioeconomic status were investigated. Baseline characteristics, prior revascularization on the ipsilateral limb and amputation outcomes were compared between races and the five DCI groups (prosperous, comfortable, mid-tier, at-risk, distressed) using Pearson chi and student t-test. RESULTS The cohort consisted of 14,816 cases of amputations. As seen in table I, when comparing DCI groups, the AKA rate was highest in the distressed group while prior revascularization was lowest (p<0.001). Thirty-day and one-year mortality were equal among the groups as well as the postoperative complication rate. Ambulation at long term follow up progressively decreased through the groups from 60.5% in the prosperous group to 49.6% in the distressed group (p<0.001). When comparing races (table II) the black group had a higher rate of AKA and a lower rate of primary revascularization when compared to the white group. The black group also had the lowest rate of ambulation at follow up. CONCLUSIONS Lower socioeconomic status and minority race is associated with a higher rate of AKA, a lower rate of primary revascularization and a low chance at future ambulation nationwide. Disadvantaged patients have historically undergone higher level amputations without prior limb salvage interventions when compared with other populations. We sought to determine if racial and socioeconomic status is associated with decreased access to vascular care, less attempts of primary revascularization and higher level amputations. The Vascular Quality Initiative was queried from 2012-2020 for patients with below-knee and above-knee amputations (AKA). Outcomes based on race and distressed community index (DCI) as a marker of socioeconomic status were investigated. Baseline characteristics, prior revascularization on the ipsilateral limb and amputation outcomes were compared between races and the five DCI groups (prosperous, comfortable, mid-tier, at-risk, distressed) using Pearson chi and student t-test. The cohort consisted of 14,816 cases of amputations. As seen in table I, when comparing DCI groups, the AKA rate was highest in the distressed group while prior revascularization was lowest (p<0.001). Thirty-day and one-year mortality were equal among the groups as well as the postoperative complication rate. Ambulation at long term follow up progressively decreased through the groups from 60.5% in the prosperous group to 49.6% in the distressed group (p<0.001). When comparing races (table II) the black group had a higher rate of AKA and a lower rate of primary revascularization when compared to the white group. The black group also had the lowest rate of ambulation at follow up. Lower socioeconomic status and minority race is associated with a higher rate of AKA, a lower rate of primary revascularization and a low chance at future ambulation nationwide.