Socioeconomic and hospital-related predictors of amputation for critical limb ischemia

Henry, Antonia J.; Hevelone, Nathanael D.; Belkin, Michael; Nguyen, Louis L.

doi:10.1016/j.jvs.2010.08.077

Cited by 175Peripheral Artery Disease ManagementHealth disparities and outcomesDiabetic Foot Ulcer Assessment and Management

Socioeconomic and hospital-related predictors of amputation for critical limb ischemia

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Henry, Antonia J., Hevelone, Nathanael D., Belkin, Michael, Nguyen, Louis L.·2011·Journal of Vascular Surgery

DOI 10.1016/j.jvs.2010.08.077PMC PMC3282120

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Abstract

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 co-morbidities. 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 (OR 1.74, P<.001). Patients at higher LER volume centers (OR 15.16, P <0.001), admitted electively (OR 2.19, P <0.001) and evaluated with diagnostic imaging (OR 10.63, P <0.001) were more likely to receive LER. Conclusions After controlling for co-morbidities, 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.

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Patients with lower socioeconomic status and those on Medicaid insurance are more likely to receive amputation for critical limb ischemia even after controlling for medical comorbidities.
“Patients with lower socioeconomic status and those on Medicaid insurance are also more likely to receive amputation for critical limb ischemia even after controlling for medical comorbidities.44”
From Racial and Ethnic Disparities in Peripheral Artery Disease (2021) · cites this paper as [44]

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Comorbidity measures for use with administrative data.
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PVSS12. Socioeconomic and Hospital-Related Predictors of Amputation for Critical Limb Ischemia
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Racial Disparities Exist in Amputation Outcomes Associated With Critical Limb Ischemia
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Lower socioeconomic status is associated with higher rates of critical limb ischemia presentation and post-revascularization amputation
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Outcomes for critical limb ischemia are driven by lower extremity revascularization volume, not distance to hospital
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A Prospective Analysis of Critical Limb Ischemia: Factors Leading to Major Primary Amputation versus Revascularization
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Authors: Henry, A. J., Hevelone, N. D., Belkin, M., & Nguyen, L. L.
Affiliations: Brigham and Women's Hospital (US)
Corresponding author: Nguyen, Louis L.
ORCID: Hevelone, Nathanael D.
Venue: Journal of Vascular Surgery
Publisher: Elsevier BV
Published: 2011-02
Volume: 53
Issue: 2
Pages: 330-339.e1
ISSN: 0741-5214 (ISSN-L)
DOI: 10.1016/j.jvs.2010.08.077
PMC: PMC3282120
OpenAlex: W2065401619
Semantic Scholar: 7b4a5b6c811fd92b5ee8257fd47f5b3ce7142ad5
Cited by: 175
References: 37
Citations by year: 2026: 5 · 2025: 15 · 2024: 13 · 2023: 24 · 2022: 20 · 2021: 21 · 2020: 9 · 2019: 12 · 2018: 10 · 2017: 7 · 2016: 15 · 2015: 7 · 2014: 6 · 2013: 8 · 2012: 3
FWCI: 3.71
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 928 d)
Locations: Journal of Vascular Surgery (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (5t32hl007734-30)
National Institute on Aging (P01AG010120)
National Heart, Lung, and Blood Institute (T32 HL00734, T-32HL007734, L30 HL090383, K06HL000734, K23HL084386)
Topics: Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
Social Sciences › Health › Health disparities and outcomes
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
Keywords: critical limb ischemia, major amputation, socioeconomic status, lower extremity revascularization, hospital volume, health disparities, Medicaid, race, income, insurance status, limb salvage, diagnostic imaging
MeSH terms: Aged, Amputation, Surgical, Diagnostic Imaging, Female, Hospital Bed Capacity, Hospitals, Humans, Insurance, Health, Ischemia, Male, Medicaid, Minority Groups, Residence Characteristics, Risk Factors, Socioeconomic Factors, United States, Logistic Models, Odds Ratio, Elective Surgical Procedures, Risk Assessment, Limb Salvage, Lower Extremity, Healthcare Disparities

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Socioeconomic and hospital-related predictors of amputation for critical limb ischemia

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