Racial differences in primary and repeat lower extremity amputation: results from a multihospital study.

Area of Science:

• Vascular Surgery
• Health Disparities Research
• Epidemiology

Background:

• African Americans experience higher rates of major lower extremity amputation.
• They also undergo limb-preserving vascular surgery or angioplasty less frequently than white patients.

Purpose of the Study:

• To analyze racial disparities in major lower extremity amputation.
• Investigate primary amputation (without prior revascularization) and repeat amputation (following a previous amputation) pathways.

Main Methods:

• Retrospective review of 248 African American, 30 Hispanic, and 235 white/other-race patients undergoing amputation (1995-2003).
• Analysis adjusted for demographics, chronic disease, functional status, and clinical presentation.

Main Results:

• African American patients were 1.7 times more likely to undergo primary amputation (P=.01).
• African American patients were 1.7 times more likely to undergo repeat amputation (P=.03).
• Race remained a significant independent risk factor, irrespective of illness severity or presentation complexity.

Conclusions:

• Elevated primary and repeat amputation rates for African Americans were observed even at institutions with strong vascular capacity.
• These disparities may be more pronounced at less resourced facilities.
• Improving access to primary and preventive care for lower-income populations could mitigate amputation rates among African Americans.