Lower Extremity Amputation in the Unhoused Population

Area of Science:

• Vascular Surgery
• Health Disparities
• Population Health

Background:

• Unhoused individuals face higher risks for lower extremity amputation due to prevalent cardiovascular disease, diabetes, and infection treatment failures.
• This study addresses critical knowledge gaps regarding care disparities for unhoused patients undergoing amputation.

Purpose of the Study:

• To identify disparities in preoperative optimization and postoperative outcomes between housed and unhoused patients undergoing lower extremity amputation.
• To inform patient management strategies and improve long-term outcomes for high-risk unhoused populations.

Main Methods:

• Retrospective analysis of 1,304 patients undergoing major lower extremity amputation (2007-2021) at a single institution.
• Utilized generalized estimating equations and multivariable models to compare outcomes between housed and unhoused cohorts.

Main Results:

• Unhoused patients were younger at amputation, more likely to be smokers, and less likely to be on antiplatelet or statin medications prior to surgery.
• Unhoused patients had lower rates of preoperative angiograms and higher rates of postoperative surgical site infections.
• The unhoused cohort experienced significantly longer nonambulatory periods post-amputation (IRR 0.16).

Conclusions:

• Significant disparities exist in the care and outcomes of lower extremity amputation for unhoused patients.
• Unhoused patients present with unique risk factors and experience poorer postoperative recovery, including delayed ambulation.
• Street medicine clinics offer a viable model for optimizing care and follow-up for unhoused individuals.