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Disparities in Targeted Muscle Reinnervation for Major Lower Extremity Amputation
Natalie E Hassell, BA1; Valeria P Bustos, MD, MS2; Nicholas Elmer, BS3,4; JacqueLyn R Kinney, BA1; Samuel M. Manstein, MD5; Carly D. Comer, MD2; Samuel J. Lin, MD6; Arriyan Samandar Dowlatshahi, MD1
1Beth Israel Deaconess Medical Center, Boston, MA; 2Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; 3Thomas Jefferson, Philadelphia, PA; 4Beth Israel Deaconess Medical Center, Boston, PA; 5Beth Israel Deaconess Medical, Harvard Medical School, Boston, MA; 6Surgery/Plastic Surgery, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA

Introduction: Targeted muscle reinnervation (TMR) is a surgical technique that can potentially prevent the development of post-amputation pain. The purpose of this study is to evaluate trends in the utilization of TMR in the inpatient setting at the time of major lower extremity amputation.
Methods: An analysis of the Nationwide Inpatient Sample from 2016-2019 was conducted. International Classification of Disease codes were used to identify all patients who underwent major lower extremity amputation with and without TMR. An adjusted multivariable logistic regression model was performed to evaluate association between the use of TMR and patient and hospital factors.
Results: A total of 41,155 patients were analyzed. Of those, 41,058 patients (99.8%) did not receive TMR and 97 patients (0.2%) received TMR. Younger patients had greater odds of receiving TMR (OR 0.97, 95% CI 0.960.99, p<0.001). The odds of receiving TMR were 2.93 times greater in those with residential income in the highest quartile, compared to those in the lowest quartile (95% CI 1.625.29, p<0.001). Patients with private insurance were nearly three times more likely to undergo TMR than those with Medicare (OR 2.73, 95% CI 1.624.59, p<0.001). Compared to urban teaching hospitals, rural non-teaching locations had decreased odds of performing TMR (OR 0.20, 95% CI 0.060.633, p=0.006).
Conclusion: This national analysis suggests there are disparities in access to TMR. Patients who are younger, reside in a zip code in the top quartile of income nationally, have private insurance, and receive treatment at a large teaching hospital have greater odds of receiving TMR. Given that TMR has the potential to reduce pain and improve quality of life following amputation, there is a need for the healthcare system to further ensure equitable access to TMR.


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