Relationship Between Regional Spending on Vascular Care and Amputation Rate

Abstract

Importance While lower extremity revascularization is effective in preventing amputation, the relationship between spending on vascular care and regional amputation rates remains unclear. Objective To test the hypothesis that higher regional spending on vascular care is associated with lower amputation rates in patients with severe peripheral arterial disease (PAD). Design Retrospective cohort study. Setting United States Medicare patients, 2003-2010 Participants 18,463 patients who underwent major PAD-related amputation. Exposures Price-adjusted Medicare spending on revascularization procedures and related vascular care in the year before lower extremity amputation, across hospital referral regions. Main Outcome Measure(s) Correlation coefficient between regional spending on vascular care and regional rates of PAD-related amputation. Results Among patients ultimately subject to amputation, 64% were admitted to the hospital in the year prior to amputation for revascularization, wound-related care, or both; 36% were admitted only for their amputation. The mean cost of inpatient care in the year before amputation, including the amputation itself, was $22,405, but varied from $11,077 (Bismarck, North Dakota) to $42,613 (Salinas, California) (p<0.001). Patients in high-spending regions were more likely to undergo vascular procedures in crude analyses (12.0 procedures per 10,000 patients in the lowest quintile of spending, 20.4 procedures per 10,000 patients in the highest quintile of spending, p<0.0001), as well as in risk-adjusted analyses (adjusted OR for receiving a vascular procedure in highest quintile of spending = 3.5, 95 % CI 3.2-3.8, p<0.0001). While revascularization was associated with higher spending (R=0.38, p<0.001), higher spending was not associated with lower regional amputation rates (R=0.10, p=0.06). Regions most aggressive in the use of endovascular interventions which most likely to have high spending (R=0.42, p=0.002) and high amputation rates (R=0.40, p=0.004). Conclusions Regions that spend the most on vascular care is highest perform the most procedures, especially endovascular interventions, in the year before amputation. However, there is little evidence that higher regional spending is associated with lower amputation rates. This suggests an opportunity to limit costs in vascular care without compromising quality.

Impact of Pharmacologic Interventions on Peripheral Artery Disease

“…The regions that were most aggressive in the use of endovascular interventions were also most likely to have high spending (R=0.42, P=.002) and high amputation rates (R=0.40, P=.004). 77 Further emphasis on early diagnosis, high-quality medical care and timely application of evidence-based guidance is clearly warranted in PAD management. A C C E P T E D M A N U S C R I P T …”

Determinants of decreasing major amputation rates in Germany

“…The intensity of vascular care provided to patients at risk for amputation is a determinant for amputation. Regions with the most intensive vascular care have the lowest amputation rate in the US [19].…”

A perifériás verőérbetegséggel és a cukorbetegséggel összefüggő alsó végtagi amputációk. Epidemiológiai adatok bemutatása és a megelőző stratégia lehetőségeinek elemzése

“…A munkacsoport későbbi elemzésében nem talált összefüggést az amputá-ciók területi gyakorisága és az adott terület érbetegellá-táshoz köthető anyagi ráfordítása között. Utóbbi szoros kapcsolatot mutat a revascularisatio költségeivel [43]. Összefoglalva: Az alsó végtagi amputációk és a revascularisatiós beavatkozások gyakorisága közötti kapcsolat ugyan kimutatható, azonban ennek mibenléte nem egyértelmű.…”