Socioeconomic Factors Predict Risk of Amputation

Ischemic limb amputation more likely in low-volume center for minority or low-income patients

THURSDAY, March 10 (HealthDay News) -- Patients with critical limb ischemia (CLI) are more likely to be treated in a low-volume hospital and to undergo amputation rather than limb salvage procedures if they are of a minority race, a lower socioeconomic status, or on Medicaid, according to a study published in the February issue of the Journal of Vascular Surgery.

Antonia J. Henry, M.D., of Brigham and Women's Hospital in Boston, and colleagues examined the link between socioeconomic status and access to institutions with a high volume of lower extremity revascularization (LER) cases. They identified factors that influenced which patients with CLI underwent amputation, using a sample of 958,120 cases from the 2003 to 2007 Nationwide Inpatient Sample.

The researchers found that 24.2 percent of CLI patients underwent amputation. Lower-income patients, minority patients, and patients with Medicaid were more likely to be treated at centers with fewer LER cases (odds ratio [OR], 1.74), and were more likely to undergo amputation. Patients were more likely to be treated with LER if they were treated at institutions with a higher volume of revascularization cases (OR, 15.16), were elective admissions (OR, 2.19), and were evaluated with angiograms (OR, 10.63).

"Minority patients tend to have lower incomes, less insurance coverage, present with more comorbidities, such as diabetes and renal failure that influence treatment options, and are more likely to receive care at low-volume and potentially under-resourced hospitals," the authors write. "Further exploration of these potential mechanisms of disparities both at the patient and the hospital level may improve limb salvage for vulnerable populations."

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