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. 2012 Dec;56(6):1663-8.
doi: 10.1016/j.jvs.2012.05.100. Epub 2012 Sep 8.

The effect of risk and race on lower extremity amputations among Medicare diabetic patients

Joshua B Goldberg  1 , Philip P Goodney, Jack L Cronenwett, Frank Baker
Affiliations

The effect of risk and race on lower extremity amputations among Medicare diabetic patients

Joshua B Goldberg et al. J Vasc Surg. 2012 Dec.

Abstract

Objective: The effect of national quality initiatives aiming at limiting lower extremity amputations in diabetic patients remains uncertain. We therefore explored trends in amputation among Medicare diabetic patients with a focus on those at highest risk.

Methods: The Diabetes Analytical File, an enhanced sample of all diabetic patients from the Medicare 5% sample, was used to study the national incidence of amputation in diabetic patients. Within a cohort of ∼5 million diabetic patients between 1999 and 2006, we compared the incidence of amputation in high-risk (end-stage renal disease or more than three comorbidities) and low-risk groups and by race.

Results: Between 1999 and 2006, 23,976 amputations were performed, comprising 11,558 in high-risk and 12,418 in low-risk patients. The amputation rate declined over time from 4.8/1000 in 1999 to 4.4/1000 in 2006 (P<.001). High-risk patients represented a growing proportion of all amputations (33% in 1999, 50% in 2006; P<.001) despite representing 4% of diabetic patients in 1999 and 10% in 2006 (P<.001). The incidence of amputation was 29.6/1000 in the high-risk group vs 2.7/1000 in low-risk patients (P<.001). African Americans had higher rates of amputation in high-risk and low-risk groups.

Conclusions: High-risk patients represent a minority of Medicare diabetic patients but account for 50% of all amputations, and this effect is magnified in African Americans. Future quality improvement efforts should focus on high-risk patients and African Americans.

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Conflict of interest statement

Author conflict of interest: none.

The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest.

Figures

Fig 1
Fig 1
Input files contributing to the Diabetes Analytical File (DAF). DME, Durable medical equipment; HHA, home health agencies; SNF, skilled nursing facility.
Fig 2
Fig 2
Temporal trends of amputations in diabetic individuals (above-knee, below-knee, and minor), by race and comorbidity status. ESRD, End-stage renal disease.
Fig 3
Fig 3
Amputation rate among Medicare diabetic patients by risk category and race.
See this image and copyright information in PMC

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