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. 2011 Feb;53(2):330-9.e1.
doi: 10.1016/j.jvs.2010.08.077. Epub 2010 Dec 15.

Socioeconomic and hospital-related predictors of amputation for critical limb ischemia

Antonia J Henry  1 , Nathanael D Hevelone, Michael Belkin, Louis L Nguyen
Affiliations

Socioeconomic and hospital-related predictors of amputation for critical limb ischemia

Antonia J Henry et al. J Vasc Surg. 2011 Feb.

Abstract

Objective: Disparities in limb salvage procedures may be driven by socioeconomic status (SES) and access to high-volume hospitals. We sought to identify SES factors associated with major amputation in the setting of critical limb ischemia (CLI).

Methods: The 2003-2007 Nationwide Inpatient Sample was queried for discharges containing lower extremity revascularization (LER) or major amputation and chronic CLI (N = 958,120). The Elixhauser method was used to adjust for comorbidities. Significant predictors in bivariate logistic regression were entered into a multivariate logistic regression for the dependent variable of amputation vs LER.

Results: Overall, 24.2% of CLI patients underwent amputation. Significant differences were seen between both groups in bivariate and multivariate analysis of SES factors, including race, income, and insurance status. Lower-income patients were more likely to be treated at low-LER-volume institutions (odds ratio [OR], 1.74; P < .001). Patients at higher-LER-volume centers (OR, 15.16; P <.001) admitted electively (OR, 2.19; P < .001) and evaluated with diagnostic imaging (OR, 10.63; P < .001) were more likely to receive LER.

Conclusions: After controlling for comorbidities, minority patients, those with lower SES, and patients with Medicaid were more likely receive amputation for CLI in low-volume hospitals. Addressing SES and hospital factors may reduce amputation rates for CLI.

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