The DOI matches its Crossref record; 31 of the 32 references it cites were found in a registry or an index.
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.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Disparities in revascularization and amputation rates differ by region.117”
From Racial and Ethnic Disparities in Peripheral Artery Disease (2021) · cites this paper as [117]
The cited source says what the claim attributes to it.
In the citing paper
“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]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Hirsch, A. T., Haskal, Z. J., Hertzer, N. R., Bakal, C. W., Creager, M. A., Halperin, J. L., Hiratzka, L. F., Murphy, W. R. C., Olin, J. W., Puschett, J. B., et al. (2006) · Circulation · doi:10.1161/circulationaha.106.174526 · Cited by 3,708
Selvin, E., & Erlinger, T. P. (2004) · Circulation · doi:10.1161/01.cir.0000137913.26087.f0 · Cited by 1,885
Fisher, E. S., Wennberg, D. E., Stukel, T. A., Gottlieb, D. J., Lucas, F. L., & Pinder, É. L. (2003) · Annals of Internal Medicine · doi:10.7326/0003-4819-138-4-200302180-00006 · Cited by 1,537
Self-citationFisher, E. S., Wennberg, D. E., Stukel, T. A., Gottlieb, D. J., Lucas, F. L., & Pinder, É. L. (2003) · Annals of Internal Medicine · doi:10.7326/0003-4819-138-4-200302180-00007 · Cited by 1,341
Self-citationNational trends in lower extremity bypass surgery, endovascular interventions, and major amputations
Goodney, P. P., Beck, A. W., Nagle, J., Welch, H. G., & Zwolak, R. M. (2009) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2009.01.035 · Cited by 674
Self-citationLeng, G. C., Lee, A. J., FOWKERS, F. G. R., Whiteman, M., Dunbar, J., Housley, E., & Ruckley, C. V. (1996) · International Journal of Epidemiology · doi:10.1093/ije/25.6.1172 · Cited by 663
Morbidity and mortality in hypertensive adults with a low ankle/arm blood pressure index
Newman, A. B. (1993) · JAMA · doi:10.1001/jama.270.4.487 · Cited by 300
Morbidity and Mortality in Hypertensive Adults With a Low Ankle/Arm Blood Pressure Index
Newman, A. B. (1993) · JAMA · doi:10.1001/jama.1993.03510040091035 · Cited by 257
Wrobel, J. S., Mayfield, J. A., & Reiber, G. E. (2001) · Diabetes Care · doi:10.2337/diacare.24.5.860 · Cited by 248
Health Care Quality, Geographic Variations, and the Challenge of Supply-Sensitive Care
Fisher, E. S., & Wennberg, J. E. (2003) · Perspectives in biology and medicine · doi:10.1353/pbm.2003.0004 · Cited by 196
Self-citation
Flagged first, then by citations
1 of the 32 references couldn’t be matched to a known paper.
Research works printed but not linked: 2
- Quanstrum, 2011, Racial disparities in end-of-limb care among medicare amputees, J Vasc Surg, 54, 420
- CPT schedule. Available at: http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt.page. Accessed January 17, 2013.
Cited by
Sorted by citations
Global Vascular Guidelines on the management of chronic limb-threatening ischemia.
Conte, M. S., Bradbury, A. W., Kolh, P., White, J. V., Dick, F., Fitridge, R., Mills, J. L., Ricco, J.-B., Suresh, K. R., Murad, M. H., et al. (2019) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2019.02.016 · Cited by 2,015
Global vascular guidelines on the management of chronic limb-threatening ischemia
Conte, M. S., Bradbury, A. W., Kolh, P., White, J. V., Dick, F., Fitridge, R., Mills, J. L., Ricco, J.-B., Suresh, K. R., Murad, M. H., et al. (2019) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2019.05.006 · Cited by 1,582
Hingorani, A., LaMuraglia, G. M., Henke, P. K., Meissner, M. H., Loretz, L., Zinszer, K. M., Driver, V. R., Frykberg, R. G., Carman, T. L., Marston, W. A., et al. (2016) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2015.10.003 · Cited by 641
Self-citationThe Current State of Critical Limb Ischemia
Farber, A. M., & Eberhardt, R. T. (2016) · JAMA Surgery · doi:10.1001/jamasurg.2016.2018 · Cited by 304
Nationwide Trends of Hospital Admission and Outcomes Among Critical Limb Ischemia Patients
Agarwal, S., Sud, K., & Shishehbor, M. H. (2016) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2016.02.040 · Cited by 267
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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
