ArticleThe Journal of surgical research2025
Causation Not Correlation: Simple Mediation Analysis of Amputation Costs.
Article in The Journal of surgical research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
Abstract
introductionThe COVID-19 pandemic significantly impacted health-care delivery and hospital financials. This study aims to identify the pandemic's effects on costs associated with nonelective major lower extremity amputation (LEA) and mediating factors influencing this cost.
methodsThe 2019-2021 Florida Agency for Health Care Administration database was queried for adult patients who underwent nonelective LEA. Patient inflation-adjusted costs were collected. Florida COVID-19 mortality rates established 9-month COVID-heavy (CH) and COVID-light (CL) timeframes, compared to a 9-month pre-COVID (PC; 2019) timeframe. Simple mediation analysis with 2000 bootstrapping interactions evaluated patient comorbidity, surgical complications, and hospital treatment factors as potential mediators on cost.
resultsA total of 5963 patients were included (1957 PC, 1994 CH, 2012 CL). Compared to PC, COVID timeframes had significantly increased total (+7.8%), hospital (+14.5%), intensive care unit (+14.3%), and operating room (+14.9%) costs. Simple mediation analysis identified potential influencers of increased cost: (1) acute kidney injury during CL (P = 0.03), (2) sepsis during CL (P = 0.02), and (3) electrolyte/acid-base disorders during CH and CL (P < 0.01). Sensitivity analysis (E-values) could not exclude unmeasured confounding from the model findings.
conclusionsThe COVID-19 pandemic led to substantial cost increases associated with nonelective major LEAs, but simple mediation analysis did not identify sensitive mediators to cost. This suggests systemic factors, such as supply chain disruptions and staffing shortages, may warrant investigation. The pandemic highlighted the need for resilient health-care systems that can address both acute and chronic care needs while mitigating inequities exacerbated by crises.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.