Temporal Trends and Geographic Variation of Lower-Extremity Amputation in Patients With Peripheral Artery Disease

被引:150
作者
Jones, W. Schuyler [1 ,2 ]
Patel, Manesh R. [1 ,2 ]
Dai, David [1 ]
Subherwal, Sumeet [1 ,2 ]
Stafford, Judith [1 ]
Calhoun, Sarah [1 ]
Peterson, Eric D. [1 ,2 ]
机构
[1] Duke Univ, Med Ctr, Duke Clin Res Inst, Durham, NC 27710 USA
[2] Duke Univ, Med Ctr, Div Cardiol, Durham, NC 27710 USA
基金
美国医疗保健研究与质量局;
关键词
critical limb ischemia; geographic variation; lower-extremity amputation; peripheral artery disease; MEDICARE BENEFICIARIES; FOOT;
D O I
10.1016/j.jacc.2012.08.983
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives This study sought to characterize temporal trends, patient-specific factors, and geographic variation associated with amputation in patients with lower-extremity peripheral artery disease (LE PAD) during the study period. Background Amputation represents the end-stage failure for those with LE PAD, and little is known about the rates and geographic variation in the use of LE amputation. Methods By using data from the Centers for Medicare & Medicaid Services (CMS) from January 1, 2000, to December 31, 2008, we examined national patterns of LE amputation among patients age 65 years or more with PAD. Multivariable logistic regression was used to adjust regional results for other patient demographic and clinical factors. Results Among 2,730,742 older patients with identified PAD, the overall rate of LE amputation decreased from 7,258 per 100,000 patients with PAD to 5,790 per 100,000 (p < 0.001 for trend). Male sex, black race, diabetes mellitus, and renal disease were all independent predictors of LE amputation. The adjusted odds ratio of LE amputation per year between 2000 and 2008 was 0.95 (95% CI: 0.95-0.95, p < 0.001). Conclusions From 2000 to 2008, LE amputation rates decreased significantly among patients with PAD. However, there remains significant patient and geographic variation in amputation rates across the United States. (J Am Coll Cardiol 2012;60:2230-6) (C) 2012 by the American College of Cardiology Foundation
引用
收藏
页码:2230 / 2236
页数:7
相关论文
共 12 条
[1]   Major lower extremity amputations at a Veterans Affairs hospital [J].
Cruz, CP ;
Eidt, JF ;
Capps, C ;
Kirtley, L ;
Moursi, MM .
AMERICAN JOURNAL OF SURGERY, 2003, 186 (05) :449-454
[2]   Geographic Variation and Trends in Carotid Imaging Among Medicare Beneficiaries, 2001 to 2006 [J].
Curtis, Lesley H. ;
Greiner, Melissa A. ;
Patel, Manesh R. ;
Duncan, Pamela W. ;
Schulman, Kevin A. ;
Matchar, David B. .
CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES, 2010, 3 (06) :599-606
[3]   Comorbidity measures for use with administrative data [J].
Elixhauser, A ;
Steiner, C ;
Harris, DR ;
Coffey, RN .
MEDICAL CARE, 1998, 36 (01) :8-27
[4]   Variation in the Use of Lower Extremity Vascular Procedures for Critical Limb Ischemia [J].
Goodney, Philip P. ;
Travis, Lori L. ;
Nallamothu, Brahmajee K. ;
Holman, Kerianne ;
Suckow, Bjoern ;
Henke, Peter K. ;
Lucas, F. Lee ;
Goodman, David C. ;
Birkmeyer, John D. ;
Fisher, Elliott S. .
CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES, 2012, 5 (01) :94-U175
[5]   National trends in lower extremity bypass surgery, endovascular interventions, and major amputations [J].
Goodney, Philip P. ;
Beck, Adam W. ;
Nagle, Jan ;
Welch, H. Gilbert ;
Zwolak, Robert M. .
JOURNAL OF VASCULAR SURGERY, 2009, 50 (01) :54-60
[6]   ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (Lower extremity, renal, mesenteric, and abdominal aortic): Executive summary [J].
Hirsch, AT ;
Haskal, ZJ ;
Hertzer, NR ;
Bakal, CW ;
Creager, MA ;
Halperin, JL ;
Hiratzka, LF ;
Murphy, WRC ;
Olin, JW ;
Puschett, JB ;
Rosenfield, KA ;
Sacks, D ;
Stanley, JC ;
Taylor, LM ;
White, CJ ;
White, J ;
White, RA ;
Antman, EM ;
Smith, SC ;
Adams, CD ;
Anderson, JL ;
Faxon, DP ;
Fuster, V ;
Gibbons, RJ ;
Halperin, JL ;
Hiratzka, LF ;
Hunt, SA ;
Jacobs, AK ;
Nishimura, R ;
Ornato, JP ;
Page, RL ;
Riegel, B .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2006, 47 (06) :1239-1312
[7]   Optimal treatment of infected diabetic foot ulcers [J].
Jude, EB ;
Unsworth, PF .
DRUGS & AGING, 2004, 21 (13) :833-850
[8]   Location, Location, Location: Geographic Clustering of Lower-Extremity Amputation Among Medicare Beneficiaries With Diabetes [J].
Margolis, David J. ;
Hoffstad, Ole ;
Nafash, Jeffrey ;
Leonard, Charles E. ;
Freeman, Cristin P. ;
Hennessy, Sean ;
Wiebe, Douglas J. .
DIABETES CARE, 2011, 34 (11) :2363-2367
[9]   Inter-society consensus for the management of peripheral arterial disease (TASC II) [J].
Norgren, L. ;
Hiatt, W. R. ;
Dormandy, J. A. ;
Nehler, M. R. ;
Harris, K. A. ;
Fowkes, F. G. R. .
EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 2007, 33 :S5-S75
[10]  
Patel MR, 2010, ARCH INTERN MED, V170, P1218, DOI 10.1001/archinternmed.2010.194