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

Abstract

Objectives We 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 use of LE amputation. Methods 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 65 years or older 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 declined from 7,258 per 100,000 PAD patients 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 PAD patients. There however remains significant patient and geographic variation in amputation rates across the United States.

Race and Socioeconomic Status Independently Affect Risk of Major Amputation in Peripheral Artery Disease

“…Supervised exercise therapy, which is now covered by Medicare for first‐line treatment of claudication, may help prevent progression of PAD to CLI and amputation. Contemporary studies have shown a decline in amputation rates for Medicare beneficiaries with PAD in general and across racial subgroups, although disparities still exist 3, 38. Multidisciplinary preventative measures such as diabetic control and wound care, along with patient and community engagement, seem to decrease racial disparity in limb loss among diabetic patients and may hold promise in PAD care 12, 38, 39.…”

“…Lack of access to care and regional clustering have been shown to affect black patients disproportionately 3, 7. Low SES has been clearly linked with higher prevalence of coronary artery disease (CAD), DM, hypertension, smoking, and physical inactivity as well as poor CAD outcomes such as myocardial infarction and cardiovascular death 14, 15.…”

Critical Limb Ischemia: Current Trends and Future Directions

“…Prognosis with respect to limb salvage and survival in CLI patients, and the PAD population as a whole, has improved over the years 24, 25, 26, 27, 28, 29, 30, 31. In a large population‐based study in a heterogeneous PAD population >65 years of age, the adjusted odds ratio of lower extremity amputation per year between 2000 and 2008 was 0.95 (95% CI: 0.95–0.95, P <0.001) 31.…”

“…In a large population‐based study in a heterogeneous PAD population >65 years of age, the adjusted odds ratio of lower extremity amputation per year between 2000 and 2008 was 0.95 (95% CI: 0.95–0.95, P <0.001) 31. Consistently, Goodney et al showed a reduction of major amputation rates of 263 to 188 per 100 000 Medicare beneficiaries between 1996 and 2006 (relative risk 0.71; 95% CI: 0.6–0.8) 28.…”

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

“…Az alsó végtagi major amputációkat (boka feletti) tekintve diabetes esetén a közölt incidenciatartomány 5,6-600/100 000, cukorbetegség nélkül 3,6-58,7/100 000. Az összefoglaló tanulmány megjelenése óta megjelent publikációk adatai a fenti incidenciatartományok értékeit nem módosították [14][15][16][17][18][19][20][21][22].…”