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250 Gender Disparities in the Acquisition of Lower Extremity Prosthetics Following Major Limb Amputation

Published online by Cambridge University Press:  03 April 2024

Julien Levy
Affiliation:
University of Michigan Medical School
Neil Kamdar
Affiliation:
University of Michigan Medical School
Widya Adidharma
Affiliation:
Michigan Medicine Section of Plastic Surgery
Stephen Kemp
Affiliation:
Michigan Medicine Section of Plastic Surgery
Rachel Hooper
Affiliation:
Michigan Medicine Section of Plastic Surgery
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Abstract

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OBJECTIVES/GOALS: The time between lower extremity amputations and prosthetic acquisition profoundly influences patient rehabilitation and mortality outcomes. Our primary outcome was time to prosthetic acquisition following major limb amputation. We hypothesize that women face an increased time lag between amputation and prosthetic acquisition compared to men. METHODS/STUDY POPULATION: We used the 2015-2021 Truven Marketscan Medicare and Commercial Claims Administrative dataset to identify individuals with lower extremity amputations based on CPT codes. We excluded patients < 18 years old, those with prior/concurrent major extremity amputations, and those with <= 31 days discontinuity in enrollment. To estimate time to prosthetic acquisition after initial amputation, Weibull Accelerated Failure Time multivariable regression models were used to estimate unadjusted and adjusted time ratios and 95% confidence intervals comparing men to women. We adjusted models for age, Medicare supplement/commercial payer, Metropolitan Statistical Area (MSA), amputation type, social deprivation index, and Elixhauser comorbidities. RESULTS/ANTICIPATED RESULTS: We identified 4,054 patients with major lower extremity amputations (75% below knee and 25% at or above knee). Patients were predominantly male (72%). For patients who received prosthetics, 39.06% of men and 31.28% of women received prosthetics within the first three months of amputation (p<0.001). Time ratios > 1 indicated longer time to prosthetic acquisition between comparison groups. The adjusted time ratio for women compared to men for the time to acquisition of prosthetics was increased; this was statistically significant (TR 1.3281, 95% CI 1.1667, 1.5118). This time ratio suggests that if a man received a prosthetic in 100 days, a women would receive her prosthetic in 133 days. DISCUSSION/SIGNIFICANCE: We found a significant difference in the time to prosthetic acquisition following major limb amputation and acquisition rate in the first three months of amputation among men and women. Successful rehabilitation, quality of life, and healthcare costs are influenced by the timeliness of prosthetic acquisition.

Type
Health Equity and Community Engagement
Creative Commons
Creative Common License - CCCreative Common License - BYCreative Common License - NCCreative Common License - ND
This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.
Copyright
© The Author(s), 2024. The Association for Clinical and Translational Science