Elsevier

Journal of Vascular Surgery

Volume 53, Issue 2, February 2011, Pages 330-339.e1
Journal of Vascular Surgery

Clinical research study
From the Peripheral Vascular Surgery Society
Socioeconomic and hospital-related predictors of amputation for critical limb ischemia

Presented at the Thirty-fifth Annual Spring Meeting of the Peripheral Vascular Surgery Society, during the 2010 Vascular Annual Meeting, Boston, Mass, June 10-13, 2010.
https://doi.org/10.1016/j.jvs.2010.08.077Get rights and content
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Objective

Disparities in limb salvage procedures may be driven by socioeconomic status (SES) and access to high-volume hospitals. We sought to identify SES factors associated with major amputation in the setting of critical limb ischemia (CLI).

Methods

The 2003-2007 Nationwide Inpatient Sample was queried for discharges containing lower extremity revascularization (LER) or major amputation and chronic CLI (N = 958,120). The Elixhauser method was used to adjust for comorbidities. Significant predictors in bivariate logistic regression were entered into a multivariate logistic regression for the dependent variable of amputation vs LER.

Results

Overall, 24.2% of CLI patients underwent amputation. Significant differences were seen between both groups in bivariate and multivariate analysis of SES factors, including race, income, and insurance status. Lower-income patients were more likely to be treated at low-LER-volume institutions (odds ratio [OR], 1.74; P < .001). Patients at higher-LER-volume centers (OR, 15.16; P <.001) admitted electively (OR, 2.19; P < .001) and evaluated with diagnostic imaging (OR, 10.63; P < .001) were more likely to receive LER.

Conclusions

After controlling for comorbidities, minority patients, those with lower SES, and patients with Medicaid were more likely receive amputation for CLI in low-volume hospitals. Addressing SES and hospital factors may reduce amputation rates for CLI.

Cited by (0)

Supported by a National Institutes of Health (NIH) K23 Research Career Development Award (HL084386) (L.L.N.) and National Research Service Award (NRSA) T32 Institutional Research Training Grant (HL00734) (A.J.H).

Competition of interest: none.

Additional material for this article may be found online at www.jvascsurg.org.

The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a competition of interest.