Temporal Trends and Geographic Variation of Lower-Extremity Amputation in Patients With Peripheral Artery Disease: Results From U.S. Medicare 2000–2008

doi:10.1016/j.jacc.2012.08.983

Journal of the American College of Cardiology

Volume 60, Issue 21, 20–27 November 2012, Pages 2230-2236

https://doi.org/10.1016/j.jacc.2012.08.983 Get rights and content

Under an Elsevier user license

open archive

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.

Key Words

critical limb ischemia

geographic variation

lower-extremity amputation

peripheral artery disease

Abbreviations and Acronyms

confidence interval

CMS

Centers for Medicare & Medicaid Services

HRR

hospital referral region

ICD-9-CM

International Classification of Diseases, Ninth Revision, Clinical Modification

LE PAD

lower-extremity peripheral artery disease

odds ratio

Cited by (0)

: 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.