Predictive characteristics of limb salvage versus amputation in lower extremity trauma: A review of the National Trauma Data Bank

Introduction: The decision between limb salvage or amputation in patients with severely injured lower extremities has major consequence to patients. There is a paucity of data on socioeconomic and institutional factors that affect this decision. We aim to evaluate the association of institutional and payment factors on management of Gustilo III lower extremity trauma. Methods: Patients with Gustilo III lower extremity injuries were identified from the National Trauma Data Bank (NTDB) from 2016 through 2017. Amputation and limb salvage outcomes were analyzed in relation to patient demographics, comorbidities, payment type, and hospital characteristics. Independent T-tests, Chi squared tests, and multivariate logistic regression was performed with statistical significance set at p < 0.05. Results: A total of 587 patients were identified, of which 81.4% were men and 18.6% were women. Sex, race, BMI, and injury severity score were not statistically different. Compared with amputation, limb salvage patients were younger (39.2 years versus 44.9 years, p = 0.001), had government-assisted health insurance (34.0% versus 14.5%, p = <.001), and were evaluated at an academic medical center (68.7% versus 53.8%, p = 0.003) or level I trauma center (73.3% vs. 64.3%, p = 0.049). Limb salvage was 1.73 times more likely at teaching hospitals versus nonteaching hospitals and 4.47 times more likely with public government-assisted insurance versus private insurance. Conclusion: This study presents data on lower extremity care following Gustilo III injuries from the NTDB. Patients are more likely to undergo limb salvage if they are evaluated at an academic center or have government-assisted health insurance.