Facility-Level Variation in Major Leg Amputation Among Patients With Newly Diagnosed Diabetic Foot Ulcer
Authors' conclusion
This cohort study of veterans with newly diagnosed DFU found significant facility-level variation in major leg amputation rates within 1 year of DFU diagnosis. Facility-level variation in 1-year mortality rates was much smaller, suggesting variation in leg amputation was likely to stem from variation in DFU-specific care. The VHA should strive to minimize the odds of major leg amputation and interfacility variation.
Study context
- Population
- Veterans with a new diagnosis of DFU at 140 Veterans Health Administration (VHA) facilities across the US, 2016–2021; 98.3% male; mean (SD) age 73.0 (8.1) years
- Participants
- 86,094 veterans
- Exposure
- Facility-level variation in major leg amputation across VHA facilities
- Outcome
- Major leg amputation
- Follow-up
- Up to 1 year from DFU diagnosis
Methodological details140 VHA facilities, multivariable mixed-effects regression with random facility intercepts
- 140 VHA facilities
- Multivariable mixed-effects regression with random facility intercepts
Main finding
As reported in the abstract
within 1 year of DFU diagnosis
Veterans with major leg amputation
3279
3.8%
Median odds ratio for facility-level variation in major leg amputation (P < .001)
1.85
Observational data: associations, not effects.
Further findings
- Median odds ratio for facility-level variation in 1-year mortality (P < .001)
- 1.16
Original publication
Facility-Level Variation in Major Leg Amputation Among Patients With Newly Diagnosed Diabetic Foot Ulcer. JAMA Netw Open. Published 1 April 2025. doi:10.
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