E. K. Awad3, K. Leibl1, C. Kerby2, T. A. Swain2, R. L. Griffin2, T. W. King2 1University Of Wisconsin,Madison, WI, USA 2University Of Alabama at Birmingham,Birmingham, Alabama, USA 3University Of South Alabama,Mobile, AL, USA
Introduction: The goal of this study was to determine if disparities exist in the care of patients with lower extremity trauma. We aimed to compare rate of limb salvage v. amputation for race, sex, age, and insurance status. We hypothesized that there would be disparities in salvage v. amputation. Uncovering these differences could help target those within disadvantaged populations and help find interventions to improve their quality of care.
Methods: The institution trauma registry was used to identify patients admitted with lower extremity injuries from 2010-2014. Lower extremity injuries were defined as any injury in the lower extremity below the pelvis and were identified by anatomical region using the abbreviated injury scale (AIS). Whole limb categories were excluded as well as injuries specific to vessels, nerves, and skin as the AIS does not specify anatomical regions for these structures below the knee. ICD-9 procedural codes for amputation were used to identify patients undergoing any amputation below the knee. Patient demographic, injury, and clinical variables were compared by amputation procedure status using the chi-square and t-test for categorical and continuous variables, respectively. Stratified analysis was completed to compare patient characteristics among those with and without amputation.
Results: Between 2010 and 2014, 6902 patients were admitted to a level 1 trauma center with a lower extremity injury, of which 131 patients underwent amputation. 105 of those patients were amputations below the knee (p<0.0001). Among those with leg injuries, those who underwent amputation had significantly longer length of stay (19.7±21.6 versus 8.8±13.3, p<0.0001) and were more likely to be male (79.39%, p=0.0021). No difference was observed for mean age (p=0.9936), race (0.0666), or injury severity score (ISS) (p=0.1495) when comparing those who underwent amputation to those who did not. The time to seek care was significantly longer (p=0.0028) when comparing those who underwent amputation (0.70 days) to those who did not (0.30 days). There was a significant difference (p<0.0001) in payment with a larger portion of those undergoing amputation having payment of other (7.63%) or workers’ compensation (9.92%) when compared to the same payment type among those without amputation.
Conclusion: There was no significant difference in amputation v. salvage by race, sex or ISS for patients with lower extremity trauma. Patients who underwent amputations were noted to have a longer length of stay and more likely to be male. The results demonstrate a significant difference in the patients who underwent amputation with those undergoing amputation having a payment type of other or workers’ compensation, demonstrating that patients who had private insurance were more likely to receive limb salvage. Further investigations utilizing a multicenter, nationwide database should be performed to verify and validate these results.