Evaluation of regional variation in total, major, and minor amputation rates in a national health-care system

Tseng, Chin‐Lin; Helmer, Drew A.; Rajan, Mangala; Tiwari, Anjali; Miller, Donald R.; Crystal, Stephen; Safford, Monika M.; Greenberg, Jeffrey D.; Pogach, Leonard

doi:10.1093/intqhc/mzm044

Cited by 43 publications

(31 citation statements)

References 24 publications

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“…16 Additionally, it is known that there is a wide range of variation in amputation rates, depending on socioeconomic characteristics and access to medical care. 17 We hypothesize that the scenario observed in the present study reflects delays in access to medical care and low socioeconomic status, which mean that many cases are admitted at a point at which preservation at the infrapatellar level is evidently impossible and revascularization attempts are equally futile.…”

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confidence: 76%

Análise dos fatores de risco relacionados às amputações maiores e menores de membros inferiores em hospital terciário

Jesus-Silva¹,

Oliveira²,

Brianezi³

et al. 2017

J. vasc. bras.

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Background: Whether they are defined as minor or major, lower limb amputations constitute a severe health problem, causing high rates of morbidity and mortality and considerable social impact. Different patient clinical characteristics appear to be related to different types of amputations. Objectives: To analyze risk factors present in patients who underwent lower limb amputations at a tertiary hospital. Methods: This was a retrospective, cross-sectional study of 109 patients who underwent lower limb amputations over a period of 31 months, analyzing gender, age, 15 clinical data and five laboratory parameters present at the time of admission. Data were treated with descriptive statistics and compared using Student' s t test for unpaired samples (for numerical variables), the Mann-Whitney test, or Fisher' s exact tests (for categorical variables). Results: There were 59 major and 50 minor amputations out of a total of 109 performed. The majority of patients were male (65%) and mean age was 65 years (range 39 to 93). Risk factors that were statistically (p < 0.05) more related to major amputations were advanced age, stroke, ischemia, sepsis, and low hemoglobin and hematocrit levels. Diabetes mellitus, neuropathy, and palpable distal pulses were factors more strongly associated with minor amputations. Conclusions: Lower limb amputations at different levels are related to different risk factors. Ischemia of greater severity and morbidity was associated with major amputations, while neuropathy and preserved perfusion were more often related to minor amputations.

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confidence: 76%

Análise dos fatores de risco relacionados às amputações maiores e menores de membros inferiores em hospital terciário

Jesus-Silva¹,

Oliveira²,

Brianezi³

et al. 2017

J. vasc. bras.

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“…Minor limb loss is defined as an amputation of the hand, digits, toes or at the mid-foot level. (2) The incidence of amputations most commonly relates to vascular conditions, trauma, malignancy, and congenital deficiency. (3).…”

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confidence: 99%

Epidemiology of Limb Loss

Varma

Stineman

Dillingham

2014

Physical Medicine and Rehabilitation Clinics of North America

142

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Synopsis In 2005, 1.6 million people were estimated to be living with limb loss and by 2050, the rate is expected to double to 3.6 million in the United States. (1) Past data has shown the rates of dysvascular amputations were on the rise. However, recent studies looking at single diseases of Peripheral Arterial Disease (PAD) and Diabetes Mellitus commonly associated with dysvascular related amputations show that these conditions are now on the decline. We believe that it may not be a single disease process but rather the cumulative illness burden that is leading to amputations. In addition to etiology, age, gender, and race continue to play a role in limb loss. Limb loss is more common among older individuals, men, and non-whites. Trauma and cancer related amputations are on the decline and congenital amputations are unchanged in rates.

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“…Second, an increased emphasis on foot care and surveillance programs could lead to earlier recognition of limb-threatening conditions that could increase rates of minor amputations while decreasing rates of major amputations (9). Thus, the ratio of major/minor amputations (10), as well as simultaneous evaluation of major and minor amputations (11), have been proposed to evaluate quality of foot care. In contrast to U.S. Federal Agencies (2,3), the Organization for Economic Collaboration and Development Health Indicators Project recommended that reporting of LEA rates should be confined to major amputations (12).…”

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confidence: 99%

“…However, the VHA offers a different perspective in population-based outcomes research compared with the regional health plans, because it is a national system that functions as a “safety net,” in that access is based on entitlement without consideration of pre-existing conditions (14). We have previously used combined patient-level VHA and Medicare databases to develop risk prediction models for total (15) and minor and major amputations (11) and evaluated rates of initial versus repeat amputations (16). The objective of this study was to evaluate risk-adjusted trends in initial minor, major, and total amputations among veterans in fiscal years (FYs) 2000–2004 and to determine whether trends in rates varied across racial and ethnic groups.…”

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confidence: 99%

Trends in Initial Lower Extremity Amputation Rates Among Veterans Health Administration Health Care System Users From 2000 to 2004

et al. 2011

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OBJECTIVETo evaluate temporal trends in rates of initial lower extremity amputation (ILEA) among patients with diabetes in the Veterans Health Administration (VHA).RESEARCH DESIGN AND METHODSRetrospective administrative data analysis of VHA clinic users with diabetes in fiscal years (FY) 2000 to 2004 (1 October 1999–30 September 2004). We calculated annual age– and sex–standardized rates of initial major, minor, and total amputations for the overall population and for various racial/ethnic groups (African Americans, Hispanics, and whites). Trends in ILEA risk were evaluated with and without adjustment for demographic characteristics and other potential risk factors, including presence of microvascular and macrovascular diseases, and antiglycemic treatment.RESULTSStudy populations of VHA patients with diabetes and without prior amputations ranged from 405,580 in FY 2000 to 739,377 in FY 2004. Age- and sex-standardized ILEA rates decreased by 34% (7.08/1,000 patients in FY 2000 to 4.65/1,000 patients in FY 2005) during the 5-year period. Minor and major amputation rates decreased by 33% (4.59 to 3.06/1,000) and 36% (2.49 to 1.59/1,000), respectively. Of major amputations, below-knee rates decreased from 1.08 to 0.87/1,000 (−19%), and above-knee decreased from 1.41 to 0.72/1,000 (−49%). Similar trends were seen for all racial groups. ILEA risk decreased by 28% (odds ratio 0.72 [95% CI 0.68–0.75]) when FY 2004 was compared with FY 2000 in the model, adjusting for demographic characteristics. This risk decrease was 22% in the model adjusting for all independent variables (odds ratio 0.78 [95% CI 0.74–0.82]).CONCLUSIONSDownward 5-year trends in ILEA rates were observed for all amputation levels and among all racial groups, even after adjustment for risk differences over time.

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Evaluation of regional variation in total, major, and minor amputation rates in a national health-care system

Abstract: Simultaneous evaluation of major and minor amputation rates identifies different patterns of regional outlier status compared to total or major amputation rates alone. This strategy may facilitate targeted evaluations of health-care processes and structures.

Cited by 43 publications

References 24 publications

Análise dos fatores de risco relacionados às amputações maiores e menores de membros inferiores em hospital terciário

Análise dos fatores de risco relacionados às amputações maiores e menores de membros inferiores em hospital terciário

Epidemiology of Limb Loss

Trends in Initial Lower Extremity Amputation Rates Among Veterans Health Administration Health Care System Users From 2000 to 2004

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