Insurance type is a major predictor of lower extremity amputation following infra-popliteal arterial trauma

Background: Following traumatic infrapopliteal arterial injury, salvageability of the leg is often attributed to injury-related variables. We investigated factors influencing amputation. Method: The United States’ National Trauma Data Bank was retrospectively examined identifying subjects aged ≥ 18 with tibial arterial injuries. Demographic, injury-related, co-morbid, and other variables were analyzed. Univariate and multivariable analyses determined predictors of lower extremity amputation. Results: 1921 subjects were included, mean age 38 years, 82% male, 65% had blunt injury, 58% white and 22% black. Insurance status: Private 24%, Self-Pay 20%, Medicare/Medicaid 17%, Other 14%, and Not-billed 1%. Average stay (days): ICU (4), hospital (15). Mortality was 2.5%. 13.6% had lower extremity amputation (10.6% below knee) and independent predictors of amputation were: male gender (OR:1.66,CI:1.11-2.34, P=0.012), Injury Severity Score (OR:1.62,CI:1.02-2.38, P<0.001), insurance status: Self-Pay (OR:1.76,CI:1.11-2.79, P=0.016), Medicare/Medicaid (OR:1.66, CI:1.03-2.67, P=0.039), Other (OR:1.61,CI:1.01-2.58, P=0.047), Notbilled (OR:1.52,CI:1.01-2.28, P=0.043). Conclusion: Insurance type is a major determinant of lower extremity amputation following traumatic infrapopliteal arterial injury.