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Patients Experience Significant Long-term Social and Health Challenges after Major Lower Extremity Amputation
Elina Farber, Max Zhu, BA, Thomas McNamara, BA, Thomas W. Cheng, MD, Andrea Alonso, MD, Jeffrey J. Siracuse, MD, MBA
Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine
Background: We assessed medical and social determinants of health(SDH) outcomes in patients after above-ankle amputation. Methods:A retrospective review of above ankle amputations(2018-2022) was performed at a safety-net hospital. Patients who participated in a post-operative SDH survey were included. Results:100 patients underwent above ankle amputations. Mean age was 61.5 years and 23% were female. The majority(57%) identified as Black and 21% as Hispanic. Comorbidities included diabetes(78%), chronic kidney disease(51%), coronary artery disease(31%) and congestive heart failure(23%). Before admission 62% lived at home and 37% used opioids. Guillotine amputation was performed in 35%; definitive amputations below and above-knee were 67% and 33%. Median length of stay was 7 days. Readmission at 30 days and 1-year was 13% and 43%. Mean follow-up was 839 days. At long-term follow-up, 55% lived at home, 25% used opioids and only 25% were independently ambulatory. 32% had a SDH challenge with younger patients more affected(58 vs. 63 years, P=.031). These challenges consisted of food insecurity(17%), housing insecurity(13%), transportation challenges(13%), seeking employment(8%), difficulty paying for utilities(5%) and medications(4%), seeking further education(5%), and difficulty caring for family/friends(4%). On multivariable analysis an SDH challenge was independently associated with 1-year readmission(OR 6.7, 95% CI 1.3-35.8, P<.001). Older age was associated with lower long-term independent ambulation(OR 0.92, 95% CI 0.85-0.99, P=.025). Conclusion:After above-ankle amputation, patients have significant medical and socioeconomic challenges. Fewer live at home, most do not ambulate independently and 1/3 report a socioeconomic challenge. Improvements in medical, social and rehabilitation support services are required for this vulnerable population.
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