Loss of independence as a metric for racial disparities in lower extremity amputation for diabetes: A National Surgery Quality Improvement Program (NSQIP) analysis

Zachary Spiera, Nicole Ilonzo, Harrison Kaplan, I. Michael Leitman

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Introduction: This study assessed the association between race/ethnicity and amputation with mortality and loss of independence (LOI) for diabetic gangrene. Methods: We analyzed the American College of Surgeons National Surgery Quality Improvement Program database from 2016 to 2019. Chi-squared tests were performed to evaluate differences in baseline characteristics and complications. Multivariable logistic regression was performed to model LOI and 30-day mortality. Results: 5250 patients with diabetes underwent lower extremity amputation as treatment for gangrene. Hispanic patients were more likely to undergo below the knee amputation (BKA) (P = 0.006). Guillotine amputation (GA) was associated with age > 65 (P < 0.0001), independent functional status prior to admission (P < 0.0001), and mortality (OR 1.989, 95%CI 1.29–3.065), but was not associated with LOI. Mortality was less frequent in Black patients (OR 0.432, 95%CI 0.207–0.902), but loss of independence (LOI) was more frequent in Black patients (OR 1.373, 95%CI 1.017–1.853). Hispanic patients were less likely to experience LOI (OR 0.575, 95%CI 0.477–0.693). Conclusions: LOI and mortality provide contrasting perspectives on outcomes following lower extremity amputation. Further assessment of risk factors may illuminate healthcare disparities.

Original languageEnglish
Article number108105
JournalJournal of Diabetes and its Complications
Volume36
Issue number1
DOIs
StatePublished - Jan 2022

Keywords

  • Amputation
  • Diabetes
  • Gangrene
  • Guillotine
  • Healthcare disparities
  • Loss of independence
  • Lower limb amputation

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