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Social Determinants of Health in Limb Salvage for Patients with Diabetic Lower Extremity Wounds
Yadira Villalvazo, MD, MS1
Pooja Humar, BS1
Alexandra Vagonis, BA1
Yusuf Surucu, MD1
Joseph Mocharnuk, BA1
Kripa Venkatakrishnan, BS1
Elizabeth Moroni, MD1
Peter Rubin, MD, MBA1
Brodie Parent, MD1
1University of Pittsburgh, University of Pittsburgh Medical Center, Department of Plastic Surgery, Pittsburgh, PA, USA
University of Pittsburgh Department of Plastic Surgery
2023-02-09
Presenter: Yadira Villalvazo, MD, MS
Affidavit:
The presented work represents only original work done by the research fellow.
Director Name: J. Peter Rubin
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
INTRODUCTION:
Diabetic wounds are a leading cause of non-traumatic amputations, however current limb salvage models fail to incorporate social determinants of health. This study aims to assess The Area Deprivation Index (ADI), Social Vulnerability Index (SVI) and distance to a wound center, and the influence on healing and amputation in patients with diabetic lower extremity wounds.
METHODS:
A cohort study (2015-2022) of 17 outpatient wound clinics was used to identify patients with at least one LE wound. SVI, ADI and wound clinic proximity was calculated. Outcomes included number of LE wounds, 7-year healing status, number of LE surgical procedures (LESP), amputations, and outpatient visits. Multivariate logistic regression and Cox regression were performed.
RESULTS:
Patients living in higher socioeconomic neighborhoods were more likely to have healed wounds (p=0.03) when compared to their counterparts. Living more than fifty miles from the nearest wound center was associated with more LESP (OR=1.18, 95%CI 1.01-1.34, p=0.04). When compared to racial/ethnic minorities, White patients were half as likely to undergo additional LESP (OR= 0.9033, 95%CI 0.85-0.96, p=0.0003), but more likely to have outpatient encounters (OR=1.01, 95%CI 1.00-1.02, p=0.01) despite equal distance to a wound center (p=0.2). Patients in areas with higher unemployment were more likely to receive an amputation (HR=14.45, 95%CI 12.28-16.63, p-value=0.016).
CONCLUSION:
In patients with diabetic LE wounds, racial/ethnic minorities and lower socioeconomic status were associated with more LESP and amputations. This data can help target specific factors such as identifying implicit-bias, education, and healthcare access that can be incorporated into limb salvage programs.
