Peripheral Arterial Testing Before Lower Extremity Amputation Among Medicare Beneficiaries, 2000 to 2010

Vemulapalli, Sreekanth; Greiner, Melissa A.; Jones, W. Schuyler; Patel, Manesh R.; Hernandez, Adrian F.; Curtis, Lesley H.

doi:10.1161/circoutcomes.113.000376

Cited by 44 publications

(31 citation statements)

References 30 publications

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“…A Medicare claims based report showed that the rate of any pre-amputation arterial testing (Doppler measurement, vascular imaging) was 68.4%. 45 Although no Hungarian or European data are available for comparison, this single observation cautions against over-interpretation of the primary amputation rate.…”

Section: Discussionmentioning

confidence: 92%

Trends in Major Lower Limb Amputation Related to Peripheral Arterial Disease in Hungary: A Nationwide Study (2004–2012)

Ferenci

Kováts

Kovács

et al. 2015

European Journal of Vascular and Endovascular Surgery

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According to this whole population based study from Hungary, the incidence of lower limb major amputation is high with no change over the past 9 years. An explanation for this remains to be determined, as the traditional risk factors in Hungary do not account for it. The characteristics of major amputation (the rate of primary amputation, the ratio of below to above knee amputation and the age of the affected population) underline the importance of screening, early detection, improved vascular care and an optimal revascularization policy. Standardization and validation of amputation detection methods and reporting is essential.

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Section: Discussionmentioning

confidence: 92%

Trends in Major Lower Limb Amputation Related to Peripheral Arterial Disease in Hungary: A Nationwide Study (2004–2012)

Ferenci

Kováts

Kovács

et al. 2015

European Journal of Vascular and Endovascular Surgery

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“…The overall revascularization rates in this cohort (77%) are lower than in the CRITISCH registry; these differences may be explained by a wider inclusion of all hospitals, as opposed to tertiary vascular centers. Medicare-based studies have also shown that a significant percentage of patients do not undergo lower extremity testing with ABIs or imaging prior to major amputation; it is possible that some patients in this cohort were not recognized clinically as having CLI, and were, therefore, not offered revascularization 20 . Importantly, studies of the regional intensity of revascularization rates have suggested that increased rates of revascularization are associated with low rates of major amputation 21,22 .…”

Section: Discussionmentioning

confidence: 99%

Risk of major amputation or death among patients with critical limb ischemia initially treated with endovascular intervention, surgical bypass, minor amputation, or conservative management

Armstrong

Ryan

Baker

et al. 2017

Journal of Medical Economics

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“…It was reported that in the US amputation was the first choice of treatment in as many as 67% of patients with CLI. In 31.8-50% of patients with CLI, leg amputation was undergone without earlier diagnostic procedures which might otherwise have shown the potential of revascularization [17]. For example, arteriography was performed in 16% of them, ABI was measured in 35% of patients, and only 26% of patients were consulted by a cardiologist and 21% by a vascular surgeon.…”

Section: Discussionmentioning

confidence: 99%

Koszty szpitalnego leczenia z powodu krytycznego niedokrwienia kończyn dolnych u pacjentów, u których ostatecznie przeprowadzono amputację kończyny. Obserwacje z jednego ośrodka

Budzyński¹,

Wnęk

Banaś

et al. 2017

MBS

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S u m m a r y B a c k g r o u n d . Currently, the average amputation free survival in patients with critical limb ischemia (CLI) amounts to 76% after one year of follow-up. Such poor prognosis raises the question: is revascularization in patients with CLI cost-effective? The aim of this study was to conduct a cost analysis of vascular care in patients with CLI.The aim of this study was to conduct a cost analysis of vascular care in patients with CLI. P a t i e n t s a n d m e t h o d s . A retrospective cost analysis of in-hospital endovascular treatment in 37 patients with CLI who underwent secondary leg amputation between January 2012 and June 2015.R e s u l t s . The average length of time between the first endovascular procedure due to CLI and leg amputation amounted to 214 days (range 8-1088 days). The total cost of hospitalizations before leg amputation amounted to 687 603.13 PLN, which is, on average, 18 583.87 PLN per patient, and 86.84 PLN per person per day for living with the preserved lower limb. The total costs associated with the patients who had undergone leg amputation amounted to 404 883.24 PLN, which is an average of 10 942.79 PLN per patient. Previous endovascular procedures accounted for 58.9% of this sum and 37.1% to total management costs for the patients.C o n c l u s i o n s . The cost per day of endovascular treatment that makes it possible to live with two lower limbs did not exceed the established cost-effectiveness threshold. Lower limb amputation increases the costs of in-hospital patient care by 59%, represents financial wastage for the hospital, and incurs other costs not easily measured.S t r e s z c z e n i e W s t ę p . Obecnie około 76% pacjentów z krytycznym niedokrwieniem kończyn dolnych (KNKD) poddanych rewaskularyzacji przeżywa kolejny rok z zachowaną kończyną.Powstaje więc pytanie, czy zabiegi rewaskularyzacyjne u tych pacjentów są efektywne kosztowo, skoro 24% chorych nie korzysta z ich efektów dłużej niż przez rok? Celem niniejszej pracy była analiza kosztów opieki naczyniowej u pacjentów z KNKD.P a c j e n c i i m e t o d y . Retrospektywna analiza kosztów szpitalnego leczenia angiologicznego KNKD u 37 pacjentów poddanych wtórnej amputacji kończyny w okresie 01.2012 -06.2015. W y n i k i . Średni okres między pierwszym zabiegiem rewaskularyzacyjnym a amputacją tej kończyny wynosił 214 dni (przedział 8-1088dni). Całkowite koszty hospitalizacji związanych z zabiegami wewnątrznaczyniowymi przed amputacją kończyny wyniosły 687 603,13PLN, co średnio na pacjenta daje 18 583,87 PLN, 86,84 PLN za jeden dzień i 18 578,5 PLN za potencjalny rok życia z kończyną. Na koszty te składały się koszty stałe oraz zmienne, związane DOI: http://dx.doi.org/10.12775/MBS.2016.029 Jacek Budzyński et al. 14 głównie z liczbą implantowanych stentów (n=59) i leczeniem trombolitycznym (n=6). Natomiast całkowity koszt hospitalizacji związanych z amputacją kończyny dolnej wynosił w badanej grupie 404 883.24 PLN, co daje średnio 10 942,79 PLN na pacjenta. Suma ta stanowiła 58,9% kosztów wcześniejszych...

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Peripheral Arterial Testing Before Lower Extremity Amputation Among Medicare Beneficiaries, 2000 to 2010

Abstract: Background-Despite mild reductions in rates of lower extremity amputation over the past decade, few data exist on the use of arterial testing in patients before amputation. Methods and Results-Using

Cited by 44 publications

References 30 publications

Trends in Major Lower Limb Amputation Related to Peripheral Arterial Disease in Hungary: A Nationwide Study (2004–2012)

Trends in Major Lower Limb Amputation Related to Peripheral Arterial Disease in Hungary: A Nationwide Study (2004–2012)

Risk of major amputation or death among patients with critical limb ischemia initially treated with endovascular intervention, surgical bypass, minor amputation, or conservative management

Koszty szpitalnego leczenia z powodu krytycznego niedokrwienia kończyn dolnych u pacjentów, u których ostatecznie przeprowadzono amputację kończyny. Obserwacje z jednego ośrodka

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