Emerging National Trends in the Management and Outcomes of Lower Extremity Peripheral Arterial Disease

被引:70
作者
Hong, Michael S. [1 ]
Beck, Adam W. [1 ]
Nelson, Peter R. [1 ]
机构
[1] Univ Florida, Coll Med, Div Vasc Surg & Endovasc Therapy, Dept Surg, Gainesville, FL 32610 USA
关键词
QUALITY-OF-LIFE; AMPUTATION; BYPASS; ANGIOPLASTY;
D O I
10.1016/j.avsg.2010.08.006
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: In this study, we sought to analyze emerging national trends in the treatment of lower extremity peripheral arterial disease and associated outcomes. Methods: The Nationwide Inpatient Sample was queried between 2001 and 2007. Patients diagnosed with lower extremity atherosclerosis were selected by using the International Classification of Diseases, 9th Revision codes 440.20-440.24, resulting in an average of 307,000 annual hospitalizations. Within this group, we determined the annual number of lower extremity bypasses, endovascular interventions, and major and/or minor amputations below-the-and/or above-the-knee amputation versus toe and/or foot amputation). Chi-square analysis was performed on discharge-weighted data to compare two periods 2001-2003 and 2004-2007) to determine changes in management and differences in outcome. Multivariate logistic regression was used to identify predictors of amputation. Results: Comparing the two periods, it was found that the average annual number of endovascular interventions increased by 78% 37,692 vs. 67,248, p < 0.001), and open lower extremity bypasses decreased by 20% 68,326 vs. 54,348, p < 0.001). Annually, the total number of interventions increased by 15% 106,018 vs. 121,596, p < 0.001), whereas the number of total amputations 59,693 vs. 50,254, p < 0.001), major amputations 39,543 vs. 31,043, p < 0.001), and minor amputations 20,150 vs. 19,211, p < 0.001) performed all significantly decreased. Diabetes was the leading predictor of amputation, especially those involving the toe and forefoot. After adjusting for age and comorbidities, African Americans were found to have a 2.4 times odds of amputation as compared with Caucasians, whereas those with Medicare or Medicaid had a 1.5 times odds as compared with those having private insurance or Health Maintenance Organization. Conclusions: Between the periods examined, we observed that the treatment of lower extremity peripheral arterial disease has evolved with increased use of lesser invasive endovascular techniques and fewer open lower extremity bypasses. These trends are associated with fewer major lower extremity amputations. Significant socioeconomic disparities persist in amputation rates, with racial minorities and those with Medicare or Medicaid having higher odds of amputation.
引用
收藏
页码:44 / 54
页数:11
相关论文
共 17 条
[1]   Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial in perspective [J].
Bradbury, Andrew W. .
JOURNAL OF VASCULAR SURGERY, 2010, 51 :1S-4S
[2]   Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial [J].
Bradbury, AW ;
Ruckley, CV ;
Fowkes, FGR ;
Forbes, JF ;
Gillespie, I ;
Adam, DJ ;
Beard, JD ;
Cleveland, T ;
Bell, J ;
Raab, G ;
Storkey, H .
LANCET, 2005, 366 (9501) :1925-1934
[3]   Infrapopliteal balloon angioplasty for the treatment of chronic occlusive disease [J].
Conrad, Mark F. ;
Kang, Jeanwan ;
Cambria, Richard P. ;
Brewster, David C. ;
Watkins, Michael T. ;
Kwolek, Christopher J. ;
LaMuraglia, Glenn M. .
JOURNAL OF VASCULAR SURGERY, 2009, 50 (04) :799-805
[4]  
*HCUP US NIS, HCUP US NIS OV INT
[5]   Impact of race on the treatment for peripheral arterial occlusive disease [J].
Huber, TS ;
Wang, JG ;
Wheeler, KG ;
Cuddeback, JK ;
Dame, DA ;
Ozaki, CK ;
Flynn, TC ;
Seeger, JM .
JOURNAL OF VASCULAR SURGERY, 1999, 30 (03) :417-425
[6]   One-year prospective quality-of-life outcomes in patients treated with angioplasty for symptomatic peripheral arterial disease [J].
Kalbaugh, Corey A. ;
Taylor, Spence M. ;
Blackhurst, Dawn W. ;
Dellinger, Matthew B. ;
Trent, Annie ;
Youkey, Jerry K. .
JOURNAL OF VASCULAR SURGERY, 2006, 44 (02) :296-303
[7]  
Lee Larisse K, 2008, Adv Surg, V42, P193, DOI 10.1016/j.yasu.2008.03.014
[8]   Association between renal failure and foot ulcer or lower-extremity amputation in patients with diabetes [J].
Margolis, David J. ;
Hofstad, Ole ;
Feldman, Harold I. .
DIABETES CARE, 2008, 31 (07) :1331-1336
[9]   Prospective multicenter study of quality of life before and after lower extremity vein bypass in 1404 patients with critical limb ischemia [J].
Nguyen, Louis L. ;
Moneta, Gregory L. ;
Conte, Michael S. ;
Bandyk, Dennis F. ;
Clowes, Alexander W. ;
Seely, B. Lynn .
JOURNAL OF VASCULAR SURGERY, 2006, 44 (05) :977-983
[10]   Disparity in Outcomes of Surgical Revascularization for Limb Salvage Race and Gender Are Synergistic Determinants of Vein Graft Failure and Limb Loss [J].
Nguyen, Louis L. ;
Hevelone, Nathanael ;
Rogers, Selwyn O. ;
Bandyk, Dennis F. ;
Clowes, Alexander W. ;
Moneta, Gregory L. ;
Lipsitz, Stuart ;
Conte, Michael S. .
CIRCULATION, 2009, 119 (01) :123-130