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Public Insurance Status Is Associated With Suboptimal Quality Of Life And Satisfaction In Lower Extremity Amputees Who Receive Prosthesis Care
Alexandra Mao, BA
1, Samantha Terranella, MD
2, Yazan Duwayri, MD MBA
2, Todd J. Castleberry, PhD
3, Patsy Diaz Delgado, MS
3, Olamide Alabi, MD MS
2.
1Emory University School of Medicine, Atlanta, GA, USA,
2Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, GA, USA,
3Hanger Institute for Clinical Research and Education, Austin, TX, USA.
OBJECTIVE: Prosthesis use after major lower extremity amputation (LEA) is associated with better quality of life (QoL). However, the association between access to care and well-being (QoL and satisfaction after LEA) among LEA prosthesis users is unknown. We sought to examine socioeconomic access to care using insurance status as a proxy and well-being after LEA among those who receive a prosthesis.
METHODS: We performed a multi-center retrospective review of patients who underwent LEA between 2015-2019. Those who received care from the institutional prosthetic vendor and completed at least one well-being survey during their post-LEA care were included in the analysis. Survey data was collected with the Well-Being section of the Prosthetics Evaluation Questionnaire (PEQ-WB) which includes QoL and satisfaction subscores. Demographic, comorbidity, and operative data were stratified and compared by insurance status (public - Medicare, VA, Medicaid; private - HMO or PPO; uninsured or not reported). Given the sample sizes, logistic regression models were performed for public and private insurance holders for the primary outcome of QoL (<8= suboptimal; ≥8=optimal) and satisfaction (<7=suboptimal, ≥7=optimal), separately. A subgroup analysis was performed for those participants who completed more than one survey during follow-up to model insurance status with the outcome of increased or decreased QoL and satisfaction over time.
RESULTS: Among 73 patients who underwent LEA, the median age was 58[IQR:47,67], 71.2% were male, and 63.0% were Black. Insurance status consisted of public (49.3%), private (41.1%), uninsured (5.5%), and those with unreported insurance status (4.1%). Below knee amputation was performed in 68.5% of the cohort, and this did not differ between groups. Compared to private insurance, public insurance was associated with increased risk of suboptimal QoL (OR 3.91; 1.41-11.39, p=0.004) and increased risk of suboptimal satisfaction (OR 3.77; 1.34-11.27, p=0.005). Subanalysis of 36 cases with more than one survey collected during follow-up revealed no association between insurance status and change in QOL or satisfaction over time.
CONCLUSIONS: Patients with public insurance who undergo LEA and are fitted for prosthesis are less likely to experience optimal QoL or satisfaction after LEA. Further investigation will be undertaken in a prospective mixed methods study to examine factors that mediate or mitigate socioeconomic status and well-being among patients after LEA who did and did not receive prosthesis.
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