Geographic Variation in Amputations for Medicare Patients With Diabetic Lower-Extremity Wounds

What factors are associated with geographic variations in amputations for patients with diabetic lower-extremity (DLE) wounds?In this cross-sectional study of 707 971 Medicare DLE wounds in 306 hospital referral regions, higher regional-level economic deprivation and proportions of Black and Hispanic patients were associated with higher proportions of major amputations following DLE wounds. Among health care factors, higher podiatrist supply was associated with substantially fewer amputations, while other specialist supply and the market-level proportion of hospitals with wound management programs were not associated with amputations.These findings suggest that beyond addressing social determinants of health, regional interventions to increase podiatry supply or compensate for lack of podiatry-specific expertise may decrease DLE wound-related amputations.

Corresponding Author: Ioana Popescu, MD, MPH, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, 1100 Glendon Ave, Ste 850, Los Angeles, CA 90024 (ipopescu@mednet.ucla.edu).

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