Behavioral health comorbidities in hospital outcomes post-lower extremity amputation in patients with type 1 and type 2 diabetes.

Abstract

Peripheral artery disease leading to chronic limb threatening ischemia (CLTI) represents a significant concern for up to 11.0 % of patients with diabetes, often culminating in amputation of the affected limb. This retrospective cohort study explores frequency of comorbid behavioral health conditions (CBHCs) in patients with diabetes and hospital stay characteristics related to post-lower extremity amputation (LEA). Utilizing patient data from the Healthcare Cost and Utilization Project from 2020, patients were categorized into groups including having comorbid depression only, alcohol abuse only, drug abuse only, more than one CBHC, or no CBHC. On average, patients with at least one CBHC underwent LEA over three years earlier (59.3±12.0 years versus 62.6±12.1 years, respectively). A greater proportion of patients with at least one CBHC were non-Hispanic White people, reside in a county metro area <250,000 people, and were insured by Medicaid. Despite generally low mortality rates, patients with depression only display significantly higher survival rates relative to those without a CBHC. These findings begin exploring the socioeconomic complexities and healthcare disparities faced by patients with diabetes and behavioral health diagnoses, emphasizing the need for targeted preventive mental health screening and intervention prior to development of CLTI.