LAUSR

OBJECTIVE Socioeconomic disadvantage is a known predictor of adverse outcomes and amputation in patients with diabetes. However, its association with outcomes following major amputation has not been described. Here, we aimed to determine the association of geographic socioeconomic disadvantage with 30-day readmission and 1-year reamputation among diabetic patients undergoing major amputation. METHODS Patients from the Maryland Health Services Cost Review Commission Database who underwent major lower extremity amputation with a concurrent diagnosis of diabetes mellitus between 2015-2017 were stratified by socioeconomic disadvantage as determined by the Area Deprivation Index (ADI) (ADI1: least deprived - ADI4: most deprived). The primary outcomes were rates of 30-day readmission and 1-year reamputation, evaluated using multivariable logistic regression models and Kaplan-Meier survival analyses. RESULTS A total of 910 patients were evaluated (66.0% male, 49.2% Black race), including 30.9% ADI1 (least deprived), 28.6% ADI2, 19.1% ADI3, and 21.2% ADI4 (most deprived). After adjusting for differences in baseline demographic and clinical factors, the odds of 30-day readmission was similar among ADI groups (P>0.05 for all). Independent predictors of 30-day readmission included female sex (OR=1.45), Medicare insurance (vs. private insurance, OR=1.76), and peripheral artery disease (OR=1.49) (P<0.05 for all). Odds of 1-year reamputation was significantly greater among ADI4 (vs. ADI1, OR=1.74), those with a readmission for stump complication or infection/sepsis (OR=2.65), and those with CHF (OR=1.53) or PAD (OR=1.59) (P<0.05 for all). CONCLUSIONS Geographic socioeconomic disadvantage is independently associated with 1-year reamputation, but not 30-day readmission among Maryland patients undergoing major amputation for diabetes. A directed approach at improving postoperative management of chronic disease progression in socioeconomically deprived patients may be beneficial to reducing long-term morbidity in this high-risk group.