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Ann Vasc Surg. 2016 Jan;30:292-8.e1. doi: 10.1016/j.avsg.2015.07.040. Epub 2015 Nov 5.

Amputation Rates for Patients with Diabetes and Peripheral Arterial Disease: The Effects of Race and Region.

Author information

1
Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH; VA Outcomes Group, White River Junction Veterans Affairs Medical Center, White River Junction, VT. Electronic address: karina.a.newhall@hitchcock.org.
2
Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH.
3
Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH.
4
The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH; Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Geisel School of Medicine, Hanover, NH.
5
VA Outcomes Group, White River Junction Veterans Affairs Medical Center, White River Junction, VT; Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.

Abstract

BACKGROUND:

It remains unknown whether care of high-risk vascular patients with both diabetes and peripheral arterial disease (PAD) is improving. We examined national trends in care of patients with both PAD and diabetes.

METHODS:

A cohort of patients diagnosed with PAD and diabetes between 2007 and 2011 undergoing open or endovascular diagnostic or revascularization procedures was analyzed using Medicare claims data. Main outcome measure was amputation-free survival measured from time of initial revascularization procedure to 24 months, stratified by race and hospital referral region (HRR).

RESULTS:

From 2007 to 2011, 2.3 per 1,000 patients underwent a major amputation with the higher rate among black patients (5.5 per 1,000 vs. 1.9 per 1,000; P < 0.001) compared with nonblack. The rate varied widely by HRR (1.2 per 1,000-6.2 per 1,000), with higher variation in amputation rates in black patients (2.1-16.1 per 1,000). Overall, amputation-free survival was approximately 74.6% at 2 years, 68.4% among black patients, and 75.4% among nonblack patients, with the disparity between the 2 groups increasing over time.

CONCLUSIONS:

Prevalence of concurrent PAD and diabetes is increasing, but amputation rates and amputation-free survival vary significantly by both race and HRR. Prevention and care coordination effort should aim to limit racial disparities in the treatment and outcomes of these high-risk patients.

PMID:
26549811
PMCID:
PMC4851557
DOI:
10.1016/j.avsg.2015.07.040
[Indexed for MEDLINE]
Free PMC Article

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