Document Detail


Temporal trends and geographic variation of lower-extremity amputation in patients with peripheral artery disease: results from U.S. Medicare 2000-2008.
MedLine Citation:
PMID:  23103040     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This study sought to characterize temporal trends, patient-specific factors, and geographic variation associated with amputation in patients with lower-extremity peripheral artery disease (LE PAD) during the study period.
BACKGROUND: Amputation represents the end-stage failure for those with LE PAD, and little is known about the rates and geographic variation in the use of LE amputation.
METHODS: By using data from the Centers for Medicare & Medicaid Services (CMS) from January 1, 2000, to December 31, 2008, we examined national patterns of LE amputation among patients age 65 years or more with PAD. Multivariable logistic regression was used to adjust regional results for other patient demographic and clinical factors.
RESULTS: Among 2,730,742 older patients with identified PAD, the overall rate of LE amputation decreased from 7,258 per 100,000 patients with PAD to 5,790 per 100,000 (p < 0.001 for trend). Male sex, black race, diabetes mellitus, and renal disease were all independent predictors of LE amputation. The adjusted odds ratio of LE amputation per year between 2000 and 2008 was 0.95 (95% CI: 0.95-0.95, p < 0.001).
CONCLUSIONS: From 2000 to 2008, LE amputation rates decreased significantly among patients with PAD. However, there remains significant patient and geographic variation in amputation rates across the United States.
Authors:
W Schuyler Jones; Manesh R Patel; David Dai; Sumeet Subherwal; Judith Stafford; Sarah Calhoun; Eric D Peterson
Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural     Date:  2012-10-24
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  60     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-16     Completed Date:  2013-01-15     Revised Date:  2014-03-19    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2230-6     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Amputation / trends*,  utilization
Female
Follow-Up Studies
Humans
Lower Extremity / blood supply*,  surgery
Male
Medicare / statistics & numerical data*
Odds Ratio
Peripheral Arterial Disease / epidemiology,  surgery*
Population Surveillance*
Prognosis
Retrospective Studies
Risk Assessment / methods*
Risk Factors
United States / epidemiology
Grant Support
ID/Acronym/Agency:
T32 HL069749/HL/NHLBI NIH HHS; U19HS021092/HS/AHRQ HHS
Comments/Corrections

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