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.
","abstract_html":"<p>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. </p> <p>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. </p> <p> 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. </p> <p> 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). </p> <p>Conclusion: Our findings will serve to inform the medical professional and health policy community of the possible factors influencing DRLEA decisions.</p>","abstract_has_math":true,"creators":["Melvin, Flora Elisa"],"institution":null,"degree_name":"Ph.D.","degree_level":"Campus Access Dissertation","degree_discipline":"Health Services and Policy Management","degree_department":null,"school":null,"contributors":["Sudha Xirasagar"],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2012,"date_issued":"2012-01-01T08:00:00Z","date_published":"2012-01-01T08:00:00Z","updated_at":"2026-07-24T04:38:23Z","subjects":["Health Services Administration","Medicine and Health Sciences","Public Health","Amputation","Cost","Diabetes","Length of Stay","Provider Characteristics","Severity"],"languages":[],"rights":["© 2012, Flora Elisa Melvin"],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://scholarcommons.sc.edu/etd/1392","outbound_label":"Repository record","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["Sudha Xirasagar"]},{"key":"dc:creator","label":"Author","values":["Melvin, Flora Elisa"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"thesis:degree_discipline","label":"Discipline","values":["Health Services and Policy Management"]},{"key":"thesis:degree_level","label":"Degree Level","values":["Campus Access Dissertation"]},{"key":"thesis:degree_name","label":"Degree Name","values":["Ph.D."]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Health Services Administration","Medicine and Health Sciences","Public Health","Amputation","Cost","Diabetes","Length of Stay","Provider Characteristics","Severity"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:rights","label":"Dc Rights","values":["© 2012, Flora Elisa Melvin"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["https://scholarcommons.sc.edu/etd/1392"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["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.
"]},{"key":"dc:title","label":"Title","values":["A Profile of Diabetes-related Below Knee Amputations Using Nation-wide Patient Discharge Data: Patient, Provider, And Insurance Characteristics"]}]}],"canonical_facts":{"dc:contributor":["Sudha Xirasagar"],"dc:creator":["Melvin, Flora Elisa"],"dc:description.abstract":["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.
"],"dc:identifier":["https://scholarcommons.sc.edu/etd/1392"],"dc:rights":["© 2012, Flora Elisa Melvin"],"dc:subject":["Health Services Administration","Medicine and Health Sciences","Public Health","Amputation","Cost","Diabetes","Length of Stay","Provider Characteristics","Severity"],"dc:title":["A Profile of Diabetes-related Below Knee Amputations Using Nation-wide Patient Discharge Data: Patient, Provider, And Insurance Characteristics"],"thesis:degree_discipline":["Health Services and Policy Management"],"thesis:degree_level":["Campus Access Dissertation"],"thesis:degree_name":["Ph.D."]},"updated_at":"2026-07-24T04:38:23Z"}