Background: Patients with serious musculoskeletal infections may encounter health disparities across multiple phases of prevention and treatment, including surgical intervention. The purpose of this study was to identify and compare the predictors of surgical intervention and surgical amputation among patients with septic arthritis, osteomyelitis, and infectious myositis in a diverse cohort of patients from New Mexico.
Methods: A retrospective cohort from the University of New Mexico Health System was formed. Patients with septic arthritis, osteomyelitis, and/or infectious myositis who underwent surgical procedures or amputations were compared with those who did not, using predictive multivariable logistic regression modeling. The impact of diabetes mellitus as a predictor of surgical outcomes was evaluated.
Results: Diabetes mellitus was a predictor of both surgical procedures and amputations in a diverse cohort of patients (N = 1694). Diabetes was more common in American Indian/Alaskan Native patients. However, Black non-Hispanic and Hispanic patients were more likely to undergo amputations, compared to American Indian/Alaskan Native patients, even after adjustment for diabetes severity.
Conclusions: Racial and ethnic disparities in infection-related amputation may differ from those observed for diabetes or for general access to surgical management. Interventions intended to prevent or treat serious musculoskeletal infections should consider health disparities that differ across the clinical care process.
1 Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States
2 Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States
Martha L. Carvour
Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States
Department of Experimental Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands