Social vulnerability and patient-reported outcomes following major limb amputation: A five-year single-surgeon study

Major lower extremity amputations (MLEA), including below-knee amputation (BKA) and above-knee amputation (AKA), impacts quality of life. The Social Vulnerability Index (SVI) measures the effect of demographic and socioeconomic factors on resilience to community disasters. This study investigates the relationship between SVI and post-amputation patient-reported outcome measures (PROM) in patients with chronic lower extremity wounds undergoing MLEA. A cross-sectional study was performed from June 2022 to September 2024 at a tertiary wound care center. MLEA patients were stratified into low, average, and high SVI groups. PROMs were collected at 1-, 3-, 6-month and 1-, 3-, and 5-year intervals, including psychological distress (SRQ-20), functionality (LEFS), pain (PROMIS-3a), and resilience (CD-RISC). Ninety patients completed 201 surveys. High SVI patients-indicating greater social vulnerability-lived closer to the hospital (median 14.2 miles) compared to low SVI (28.3 miles) (p = 0.006). PROMIS-3a scores revealed higher pain levels in low SVI patients (52.8 ± 15.2) compared to average (46.5 ± 11.6) and high SVI patients (50.1 ± 13.9) (p = 0.027). LEFS scores indicated higher functionality in high SVI patients (43.9 ± 21.9) compared to low (32.6 ± 17.6) and average SVI (34.5 ± 16.5) (p = 0.003). SRQ-20 and CD-RISC scores showed no significant differences between groups. High SVI patients demonstrated better functional recovery, potentially influenced by closer proximity to hospital rehabilitation services. Conversely, low SVI patients reported higher pain levels. These findings underscore the importance of integrating social determinants of health into postoperative care strategies to optimize recovery and patient satisfaction.