Title

How Does an Understanding of the Lower Extremity Amputation Patient Population That a Large Urban Podiatric Practice Serves Improve the Care of that Population?

Document Type

Presentation

Publication Date

6-22-2017

Comments

Advisor:

J McAna, Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA

Abstract

Lower extremity amputations and diabetic foot ulcers are a major cause of morbidity, disability, as well as emotional and physical costs for a diabetic individual. Many patients are not aware of the severe complications diabetes mellitus poses on a diabetic individual’s feet including lower extremity amputations. Severe risk factors associated with lower extremity amputation are diabetic foot ulcers, smoking, and socioeconomic status. Currently, few research articles examine or attempt to understand these lower extremity populations in low-income communities. This study was a retrospective analysis of the electronic clinical records of patients who had sought post-operative outpatient treatment after undergoing a lower extremity amputation procedure at a podiatric clinic in Philadelphia from December 2015 to December 2016. Data for known risk factors (independent variables and covariates) of amputation including age, sex, race, body mass index (BMI), diabetes status, marital status, zip code, and presence of diabetic foot ulcer, smoking status, and all coexisting conditions using the Charlson Index were obtained from patient records. To further understand the lower extremity amputation (LEA) population, cross tabulations and chi-square analyses was conducted. One hundred and forty nine eligible cases were observed from 2015 to 2016. The mean age was 63 years of age, more than half (56.4%) were males, 39.6% underwent a toe amputation, 58.4% were African American, 46.3% had Medicare insurance, 63.1% had Type 2 Diabetes, and 36.2% resided in West Philadelphia. Ten cross tabulations were conducted and none were found significant. Post hoc testing did reveal a significant relationship between race and health insurance. There was a statically significant relationship between African Americans and Medicaid insurance (p=0.002). Based off this data, future recommendations focus on risk identification, patient and provider education, and the coordination and management of care among health care providers for a diabetic patient. Further research should also focus on other causes of lower extremity amputation such as peripheral vascular disease, smoking, and the impact of race and diabetes.

Presentation: 23:35