Date of Award


Document Type

Campus Access Dissertation


Health Services and Policy Management

First Advisor

Sudha Xirasagar


Background: Lower extremity amputation among patients with diabetes is a rarely studied topic. Providers' decisions regarding a below-knee Diabetes-Related Lower Extremity Amputation (DRLEA) single vs. repeat DRLEA terminating in a below-knee final amputation status are important for patient outcomes.

Objective: This research profiled DRLEA procedures among diabetic patients of all age groups from18 years of age, discharged between January 1, 2006, through December 31, 2010, from 359 member-hospitals from one of the largest consulting and group purchasing hospital consortiums in the U.S.

Methods: We conducted a retrospective analysis of secondary (claims) data on all adult cases of below-knee amputations during 2006 through 2010 (the study population). All these patients' discharges during the year prior to the index discharge were identified to characterize the DRLEA as a single-procedure (one-step) amputation or as the final step following one or more repeat major amputations during the prior year. Multiple logistic regression and general linear models were used.

Results: A total of 30,458 patients' last recorded DRLEAs (single and multi-step) looking back one year was studied. Single and multi-step Medicaid (p<.05), Commercial and Indigent/Self Pay/Other patients were most likely to be discharged home vs. other health care facilities (OHF) (averages of 64% and 81%, respectively) and single and multi-step Medicare patients were most likely and equally to be discharged to OHF (57%) vs. home. Commercial Fee-For-Service enrollees were more likely to have multi-step amputations compared to Indigent/Self pay patients (OR=1.55, P=0.0039). Patients with minor to moderate and major patient severity have higher odds of multi-step amputation (OR=1.73, 1.41 respectively, P<.0001). The total length of stay (LOS) across multiple amputations is greater than a single, one-time amputation. Larger and teaching hospitals had higher costs ($4500 higher for 500+ bed hospitals) ($1386 higher for teaching hospitals).

Conclusion: Our findings will serve to inform the medical professional and health policy community of the possible factors influencing DRLEA decisions.