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Socioeconomic and hospital-related predictors of amputation for critical limb ischemia
Open accessAbstract
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 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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Metadata
- Authors
- Henry, A. J., Hevelone, N. D., Belkin, M., & Nguyen, L. L.
- Affiliations
- Brigham and Women's Hospital (US)
- Corresponding author
- Nguyen, Louis L.
- Venue
- Journal of Vascular Surgery
- Publisher
- Elsevier BV
- Published
- 2011-02
- Volume
- 53
- Issue
- 2
- Pages
- 330-339.e1
- ISSN
- 0741-5214 (ISSN-L)
- 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
- 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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