Researchers from Brigham and Women’s Hospital at Harvard Medical School, Boston, Massachusetts, have published a study in the February issue of the Journal of Vascular Surgery claiming that disparities in limb-salvage procedures may be driven by socioeconomic status (SES) and access to high-volume hospitals, as reported in The Medical News online January 29, 2011.
The study collected data from the Nationwide Inpatient Sample taken between 2003 and 2007, reviewing 958,120 patient cases that contained lower-extremity revascularization (LER) or major amputation, as well as data taken from patients with critical limb ischemia (CLI). Findings showed an increased risk of major amputation among minority patients, while adjusting for income, insurance status, hospital volume factors, and LER incidence. Demographic trends associated with amputation (vs. LER) also included advanced age and male gender.
“Minority patients tend to have more comorbidities including diabetes, peripheral artery disease (PAD), and renal failure that influence treatment options as they are more likely to receive care at low-volume and potentially under-resourced hospitals,” the study’s senior author, Louis L. Nguyen, MD, MBA, MPH, was quoted as saying. “These factors, independently and in combination, are associated with a greater likelihood of major amputation.” He noted that patients with CLI admitted to higher volume hospitals are more likely to undergo limb-salvage procedures. Researchers added that higher-volume hospitals may have more fellowship-trained vascular specialists, established protocols for perioperative care of patients with CLI, and greater access to angiography facilities.
Patients in the lower three income quartiles were found to present 11 to 34 percent higher odds for undergoing major amputation. Patients in the second quartile also had significantly increased odds of undergoing surgery, and patients at the lowest volume centers presented 15.2 times higher odds of undergoing major amputation.
Nguyen noted that a further analysis of referral patterns and the use of outpatient healthcare could guide potential interventions that target patients at risk for major amputation.