Kammien Alexander J, Evans Brogan G, Hu Kevin G, Colen David L
From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT.
Ann Plast Surg. 2025 Apr 1;94(4S Suppl 2):S349-S352. doi: 10.1097/SAP.0000000000004209.
The current study assessed factors associated with limb salvage and subsequent amputations for patients with diabetic lower-extremity wounds in the United States.
Using national administrative data from 2010 to 2022 (PearlDiver), adults undergoing amputation or salvage procedures (skin graft, local flap, or free flap) for diabetic lower-extremity wounds were identified. Patient age, sex, Elixhauser Comorbidity Index, geographic region, and insurance status were extracted. Insulin dependence, tobacco use, end-stage renal disease, peripheral vascular disease, prior amputation, preoperative lower-extremity infection, and preoperative vascular testing or intervention were also extracted. Subsequent amputations following limb salvage were identified. Factors associated with salvage procedures and subsequent amputation were analyzed with multivariable logistic regression.
The final cohorts included 97,472 patients with amputation and 62,850 patients with salvage. The average follow-up was 3.9 years. Many patient and clinical factors were associated with limb salvage. Most notably, patients in the Northeast had the greatest odds of undergoing salvage, and relative to privately insured patients, those with Medicare and Medicaid were significantly less likely to undergo salvage. Of patients who underwent salvage, 11,595 (18%) underwent subsequent amputation at an average time of 1.7 years. There was minimal variation in subsequent amputation by geographic region, and patients with Medicare and Medicaid were only slightly more likely to undergo a subsequent amputation.
There are significant disparities in access to limb salvage procedures in the United States based on region and insurance status despite only minor differences in progression to subsequent amputation for these patients.
本研究评估了美国糖尿病下肢伤口患者保肢及后续截肢相关的因素。
利用2010年至2022年的国家行政数据（PearlDiver），识别因糖尿病下肢伤口接受截肢或保肢手术（皮肤移植、局部皮瓣或游离皮瓣）的成年人。提取患者的年龄、性别、埃利克斯豪泽合并症指数、地理区域和保险状况。还提取了胰岛素依赖、吸烟、终末期肾病、外周血管疾病、既往截肢史、术前下肢感染以及术前血管检查或干预情况。确定保肢术后的后续截肢情况。采用多变量逻辑回归分析与保肢手术及后续截肢相关的因素。
最终队列包括97472例截肢患者和62850例保肢患者。平均随访时间为3.9年。许多患者和临床因素与保肢相关。最显著的是，东北部的患者接受保肢的几率最高，相对于私人保险患者，医疗保险和医疗补助患者接受保肢的可能性显著降低。在接受保肢手术的患者中，11595例（18%）在平均1.7年时接受了后续截肢。后续截肢在地理区域上的差异极小，医疗保险和医疗补助患者接受后续截肢的可能性仅略高。
在美国，基于地区和保险状况，在获得保肢手术方面存在显著差异，尽管这些患者在后续截肢进展方面仅有微小差异。
