TY - JOUR
T1 - Temporal trends and geographic variation of lower-extremity amputation in patients with peripheral artery disease
T2 - Results from U.S. Medicare 2000-2008
AU - Jones, W. Schuyler
AU - Patel, Manesh R.
AU - Dai, David
AU - Subherwal, Sumeet
AU - Stafford, Judith
AU - Calhoun, Sarah
AU - Peterson, Eric D.
N1 - Funding Information:
This project was funded in part by internal support from the Duke Clinical Research Institute. This project also was supported on infrastructure provided by Cooperative Agreement Number U19HS021092 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. Disclosures: Dr. Patel has received research grants from Johnson & Johnson , Pluristem , and Astra Zeneca ; and is a consultant for Baxter, Genzyme, Bayer, and Ortho McNeil Jansen. Dr. Peterson has received research grants from Bristol Myers Squibb-Sanofi , Merck , Eli Lilly , and Johnson & Johnson . All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
PY - 2012
Y1 - 2012
N2 - 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.
AB - 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.
KW - critical limb ischemia
KW - geographic variation
KW - lower-extremity amputation
KW - peripheral artery disease
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U2 - 10.1016/j.jacc.2012.08.983
DO - 10.1016/j.jacc.2012.08.983
M3 - Article
C2 - 23103040
AN - SCOPUS:84869083744
SN - 0735-1097
VL - 60
SP - 2230
EP - 2236
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 21
ER -