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Regional intensity of vascular care and lower extremity amputation rates
Open accessAbstract
Objective To examine the relationship between the intensity of vascular care and population-based rate of major lower extremity amputation (above-or below-knee) from vascular disease. Background Because patient-level differences do not fully explain the variation in amputation rate across the United States, we hypothesized that variation in intensity of vascular care may also affect regional rates of amputation. Methods Intensity of vascular care was defined as the proportion of Medicare patients who underwent any vascular procedure in the year prior to amputation, calculated at the regional level (2003–2006), using the 306 hospital referral regions in the Dartmouth Atlas of Healthcare. We examined relationship between intensity of vascular care and major amputation rate, at the regional level, between 2007–2009. Results Amputation rates varied widely by region, from 1 to 27 per 10,000 Medicare patients. Compared to regions in the lowest quintile of amputation rate, patients in the highest quintile were commonly African American (50% versus 13%) and diabetic (38% versus 31%). Intensity of vascular care also varied across regions: fewer than 35% of patients underwent revascularization in the lowest quintile of intensity, while nearly 60% of patients underwent revascularization in the highest quintile. Overall, there was an inverse correlation between intensity of vascular care and amputation rate ranging from R= −0.36 for outpatient diagnostic and therapeutic procedures, to R= −0.87 for inpatient surgical revascularizations. In analyses adjusting for patient characteristics and socioeconomic status, patients in high vascular care regions were significantly less likely to undergo amputation without an antecedent attempt at revascularization (OR 0.37, 95% CI 0.34–0.37, p<0.001). Conclusions The intensity of vascular care provided to patients at risk for amputation varies, and regions with the most intensive vascular care have the lowest amputation rate, although the observational nature of associations do not impart causality. High-risk patients, especially African-American diabetic patients residing in low-intensity vascular care regions, represent an important target for systematic efforts to reduce amputation risk.
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“Namely, patients living in Southern United States (the bible belt) undergo higher rates of amputation and inversely lower rates of open or endovascular revascularization for every amputation in comparison to other states with lower amputation rates.”
From Racial and Ethnic Disparities in Peripheral Artery Disease (2021) · cites this paper as [117]
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“Furthermore, Goodney et al 117 found that amputation rates were disproportionately higher among Black Americans in regions with higher amputation rates but found no significant racial differences in regions where amputations were lower.”
From Racial and Ethnic Disparities in Peripheral Artery Disease (2021) · cites this paper as [117]
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“Disparities in revascularization and amputation rates differ by region.117”
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“Notably, patients in the highest quintile for amputation rates were also more likely to be diabetic.”
From Racial and Ethnic Disparities in Peripheral Artery Disease (2021) · cites this paper as [117]
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Metadata
- Authors
- Goodney, P. P., Holman, K., Henke, P. K., Travis, L. L., Dimick, J. B., Stukel, T. A., Fisher, E. S., & Birkmeyer, J. D.
- Affiliations
- Dartmouth Institute for Health Policy and Clinical Practice (US)
- University of Michigan (US)
- Maine Medical Center (US)
- Corresponding author
- Goodney, Philip P.
- Venue
- Journal of Vascular Surgery
- Publisher
- Elsevier BV
- Published
- 2013-06
- Volume
- 57
- Issue
- 6
- Pages
- 1471-1480.e3
- ISSN
- 0741-5214 (ISSN-L)
- PMC
- PMC3660510
- OpenAlex
- W1973843107
- Semantic Scholar
- 434abe9e01c9e8dc6bad6623ecd820d1b922e10a
- Cited by
- 162
- References
- 32
- Citations by year
- 2026: 4 · 2025: 15 · 2024: 15 · 2023: 20 · 2022: 11 · 2021: 15 · 2020: 12 · 2019: 14 · 2018: 10 · 2017: 8 · 2016: 13 · 2015: 12 · 2014: 10 · 2013: 2
- FWCI
- 12.06
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Vascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (1K08HL05676, K08HL105676)
- National Institute on Minority Health and Health Disparities (L32 MD006323)
- Topics
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Keywords
- lower limb amputation, regional variation in care, revascularization, Medicare beneficiaries, hospital referral regions, African American patients, diabetic patients, amputation risk
- MeSH terms
- Aged, Amputation, Surgical, Female, Medicare, Humans, Leg, Male, United States, Vascular Diseases, Vascular Surgical Procedures
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