Noticias

Noticias

  • Título: How Geography, Race, and Economic Status Increase Rates of Amputation
  • Fecha: 30-03-2015

  • Frank J Criado MD


    It is universally accepted that lower-extremity revascularization can save limbs and prevent amputation in peripheral arterial disease. However, it is generally unknown that in some regions of the U.S., the amount and intensity of vascular care is inversely related to the amputation rate as shown in a large study of Medicare patients presented at the Annual Vascular Meeting of the SVS Society last June. Dr. Philip P. Goodney et al from Dartmouth-Hitchcock Medical Center studied all open and endovascular revascularizations performed on 20,464 Medicare patients in the year prior to vascular-cause amputation. They scrutinized associations among patient characteristics, the regional rates of revascularization, and the regional amputation rate among the 307 hospital referral regions.

    Population-based amputation rates varied across regions, from fewer than 1 to more than 44 amputations per 10,000 Medicare patients. Rates were highest in rural regions of the southern and Appalachian U.S. Patients in regions with high amputation rates were more commonly African American than were patients in regions with low amputation rates (50% vs 12%). Furthermore, those in regions with high amputation rates had lower per capita income, compared with those in regions with low amputation rates ($17,980 vs $19,545).

    Less vascular care was provided to patients who lived where amputation rates were highest. Those patients had 57% fewer therapeutic revascularization procedures (such as bypass surgery or stent placement) than did patients in regions with low amputation rates (2.2 vs 4.8 revascularizations per amputation). Even the number of diagnostic angiograms was significantly lower in high amputation regions than in low amputation regions (2.4 vs 5.0 angiograms per amputation). It seems clear that Medicare patients living in those regions with high amputation rates tend to be poor and African American, and receive less than half as much vascular care as those in other regions. They probably present late, often with end-stage ischemia or gangrene, and miss the opportunities for revascularization and limb salvage.



  • Fuente: endovascular.es