Access to Reconstructive Plastic Surgery and Nerve Procedures in Lower Extremity Amputations

Neuroma complicates lower extremity (LE) amputations causing significant morbidity. This study examines the relationship between access to plastic surgery and the likelihood of receiving a neuroma-preventing nerve procedure with LE amputation in the United States.Using the National Inpatient Sample, 2016 to 2021, ICD-10 codes identified encounters undergoing above- or below-knee LE amputation with or without concurrent nerve procedures (targeted muscle reinnervation and regenerative peripheral nerve interface). Plastic surgery volume was determined using ICD-10-PCS codes. Outcomes included population-adjusted LE amputation incidence, odds of concurrent nerve procedures, and their incidence relative to facility plastic surgery volume. Statistical analysis included univariate analysis and multivariate Poisson and logistic regression models.A total of 245,170 weighted encounters underwent LE amputation, of which only 1,525 (0.6%) included concurrent nerve procedures. Population-adjusted LE amputation incidence remained stable throughout the study period (p = 0.159). Higher LE amputation incidence was associated with higher comorbidity burden and Black and Native American race (p ≤ 0.036). Odds of nerve procedures increased with more recent surgery year, younger age, higher income, and Black race (p ≤ 0.044). Nerve procedure incidence at facilities in the highest quartile of plastic surgery volume was significantly higher than that of facilities in the lowest quartile (incidence rate ratio: 21.949; 95% confidence interval: 16.493-29.211; p < 0.001).Amidst stable population LE amputation incidence, Black and Native American race increased LE amputation incidence. Higher income and Black race elevated odds of concurrent nerve procedures. Increasing facility plastic surgery volume was associated with increased concurrent nerve procedure incidence in LE amputation.