Facility-Level Variation in Major Leg Amputation Among Veterans With Newly Diagnosed Diabetic Foot Ulcers
Summary: This large retrospective cohort study analyzed 86,094 Veterans (mean age 73) newly diagnosed with diabetic foot ulcers across 140 VA facilities from 2016–2021. Within one year, 3.8% underwent major leg amputation. After adjusting for patient comorbidities and social drivers of health, there was significant facility-level variation: the median odds ratio (MOR) for major amputation was 1.85 — meaning the odds were 1.85 times higher at one random facility compared to another for an otherwise similar patient. Facility variation in 1-year mortality was much smaller (MOR 1.16). The findings suggest that differences in DFU-specific care (offloading, vascular evaluation, multidisciplinary management, timely intervention) are major drivers of amputation risk and represent important targets for quality improvement.
Key Highlights:
- 3.8% major amputation rate within 1 year of new DFU diagnosis
- Facility-level median odds ratio of 1.85 for amputation (wide range 0.29–3.53)
- Variation in amputation far exceeded variation in mortality, pointing to modifiable care differences
- Authors: Hiroyuki Suzuki, MD, MSCI, et al. (JAMA Network Open, 2025)
Read full article (JAMA Network Open)
Keywords: VA DFU amputation, facility variation amputation, Hiroyuki Suzuki