The Stigma of Digital Amputation: A Survey of Amputees with Analysis of Risk Factors

Abstract

Purpose: We aimed to quantify the stigma associated with digital amputation using the Neuro-QOL Stigma patient-reported outcomes instrument and examine the patient and injury factors associated with a more severe amputation stigma experience. Methods: This descriptive retrospective cohort study analyzed 164 patients who underwent digital amputation. Records were reviewed for age at amputation, sex, indication, laterality, level, number of amputated digits, and a diagnosis of depression that preceded amputation. Enrolled patients remotely completed the Neuro-QOL stigma computer adaptive test, a battery of PROMIS instruments, and a questionnaire clarifying personal/injury details. Multivariable analysis was used to identity factors associated with a more severe stigma experience.Results: Among 164 digital amputees enrolled, the observed mean Neuro-QOL Stigma score of 47.2 +/- 8 is slightly below the population mean of 50. Younger age, a worker’s compensation claim, and a diagnosis of depression at the time of amputation are each independently associated with a more severe stigma experience after digital amputation. Neither socioeconomic variables, anatomic details of the injury, nor mechanism were independently associated with Neuro-QOL Stigma. Conclusions: While we have previously targeted patients with more severe injuries for discussion of coping with physical stigma, our findings suggest that attention should perhaps instead be focused on digital amputees who are young, depressed, and/or involved with worker’s compensation. A surgeon may be of service to the at-risk patient by offering referral to a mental health provider who can offer depression treatment and/or support the patient’s process of coping and adjustment.

Management of digital amputations: commentary and personal opinions

“…The article by Bettlech et al. (2021) partially confirms what has already been mentioned, that patients may have an extraordinary ability to adapt, even from an aesthetic point of view, following digital amputation injuries.…”

“…In this article, I would like to share some of my thoughts on this subject. In particular, I would like to comment on three recently published articles (Bettlach et al., 2021; Florczynski et al., 2021; Li et al., 2021) regarding digital amputations, replantations and their treatment outcomes. In these articles, I analysed the factors associated with early and late revascularization/digital replantation, the comparative results between reimplantation and osseointegrated reconstruction, and finally the stigma associated with digital amputation.…”