Utilization of Vascular Assessment Before Lower Extremity Amputation Among Patients With Diabetic Foot Ulcerations in the US

OBJECTIVES: To explore the utilization of vascular assessment before lower extremity amputation (LEA) among patients with diabetic foot ulcerations (DFU), and to evaluate the factors such as social determinants of health associated with access to testing.

METHODS: A retrospective claims database analysis was conducted using the De-identified Clinformatics Data Mart (OptumInsight, Eden Prairie, MN) covering 2010 to 2021. We identified adult patients with DFU by confirmed diagnosis of diabetes in combination with diagnosis of foot ulceration, gangrene, or osteomyelitis. Patients were required to have undergone LEA and continuoutly enrolled for 12 months before the first amputation. We identified the utilization of common vasulcar testing procecures within 12 months before amputation. Baseline demographic and clinical characteristics were described and compared between patients who received vascular testing and those did not.

RESULTS: A total of 17,881 commerically insured DFU patients were captured in the 1% sample of the OPTUM enrollees. 714 of them underwent minor or major amputation, and 507 had 12-month continuous enrollment before amputation and thus were included for analysis. Among them, 313 (61.7%) received at least one vascular testing before amputation. Ankle-brachial index measurement was the most performed procedure (43.6%), followed by duplex ultrasound (39.3%) and invasive angiography (17.4%). Patients with vascular assessment were older than those did not (69.8 vs. 66.3 years, P<0.01). The population was predominately males in both cohorts. Less black patients got tested (13.1% vs. 19.1%). Regional variation was detected (P<0.05). Patients with vascular testing were more likely to have comorbidities, especially the peripheral arterial disesease (99% vs. 90%).

CONCLUSIONS: We found variation of access to vascular assessment before amputation by patient characteristics such as race, age, and region of care. We are accessing the 100% sample of OPTUM claims and will apply adjusted analysis to assess predictors of access to vascular testing.