The Impact of Sociodemographic Variables on Functional Recovery following Lower Extremity Amputation

Area of Science:

• Orthopedics and Rehabilitation
• Health Disparities Research
• Vascular Surgery Outcomes

Background:

• Sociodemographic factors, especially financial environment, are hypothesized to influence prosthetic use and ambulation post-major amputation.
• Understanding these disparities is crucial for improving patient outcomes and equitable access to prosthetic care.

Purpose of the Study:

• To investigate the association between sociodemographic variables and prosthetic limb acquisition after major amputation.
• To examine the impact of sociodemographic factors on achieving ambulatory status following major amputation.

Main Methods:

• Retrospective analysis of the Vascular Quality Initiative amputation module (April 2013 - January 2024).
• Inclusion criteria: patients undergoing below, through, or above knee amputation.
• Outcomes: nonambulatory status (≥120 days follow-up) and no prosthetic limb acquisition (≥90 days follow-up), analyzed using multivariable binary logistic regression.

Main Results:

• 46.7% of patients did not acquire a prosthetic limb, and 44.1% were nonambulatory.
• Factors associated with no prosthetic acquisition: older age, female sex, high area deprivation index, and specific insurance types (Medicare, Medicaid, VA).
• Factors associated with nonambulatory status: older age, female sex, Medicare insurance, congestive heart failure, and not living at home; physical therapy and commercial insurance were protective.

Conclusions:

• Financial disadvantage and race are independently associated with lower prosthetic limb acquisition rates.
• Black, Native American, and Pacific Islander patients experience higher rates of non-acquisition compared to White and Asian patients.
• Female sex is linked to reduced prosthetic use and ambulation, partly due to higher rates of above-knee amputations; comorbidities, not socioeconomic factors, are primary drivers of nonambulation.