Cited by 162Peripheral Artery Disease ManagementDiabetic Foot Ulcer Assessment and ManagementHealthcare Policy and Management

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Regional intensity of vascular care and lower extremity amputation rates

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Goodney, Philip P., Holman, Kerianne, Henke, Peter K., Travis, Lori L., Dimick, Justin B., Stukel, Therese A., Fisher, Elliott S., Birkmeyer, John D.·2013·Journal of Vascular Surgery

DOI 10.1016/j.jvs.2012.11.068PMC PMC3660510

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Abstract

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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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.
ORCID: Goodney, Philip P.
Henke, Peter K.
Dimick, Justin B.
Fisher, Elliott S.
Venue: Journal of Vascular Surgery
Publisher: Elsevier BV
Published: 2013-06
Volume: 57
Issue: 6
Pages: 1471-1480.e3
ISSN: 0741-5214 (ISSN-L)
DOI: 10.1016/j.jvs.2012.11.068
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: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 951 d)
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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Regional intensity of vascular care and lower extremity amputation rates

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