Baril Donald T, Ghosh Kaushik, Rosen Allison B
Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
National Bureau of Economic Research, Cambridge, Mass.
J Vasc Surg. 2014 Sep;60(3):669-77.e2. doi: 10.1016/j.jvs.2014.03.244. Epub 2014 Apr 24.
Acute lower extremity ischemia (ALI) is a common vascular surgery emergency associated with high rates of morbidity and mortality. The purpose of this study was to assess contemporary trends in the incidence of ALI, the methods of treatment, and the associated mortality and amputation rates in the U.S. Medicare population.
This was an observational study using Medicare claims data between 1998 and 2009. Outcomes examined included trends in the incidence of ALI; trends in interventions for ALI; and trends in amputation, mortality, and amputation-free survival rates.
Between 1998 and 2009, the incidence of hospitalization for ALI decreased from 45.7 per 100,000 to 26.0 per 100,000 (P for trend < .001). The percentage of patients undergoing surgical intervention decreased from 57.1% to 51.6% (P for trend < .001), whereas the percentage of patients undergoing endovascular interventions increased from 15.0% to 33.1% (P for trend < .001). In-hospital mortality rates decreased from 12.0% to 9.0% (P for trend < .001), whereas 1-year mortality rates remained stable at 41.0% and 42.5% (P for trend not significant). In-hospital amputation rates remained stable at 8.1% and 6.4% (P for trend not significant), whereas 1-year amputation rates decreased from 14.8% to 11.0% (P for trend < .001). In-hospital amputation-free survival after hospitalization for ALI increased from 81.2% to 85.4% (P for trend < .001); however, 1-year amputation-free survival remained unchanged.
Between 1998 and 2009, the incidence of ALI among the U.S. Medicare population declined significantly, and the percentage of patients treated with endovascular techniques markedly increased. During this time, 1-year amputation rates declined. Furthermore, although in-hospital mortality rates declined after presentation with ALI, 1-year mortality rates remained unchanged.
急性下肢缺血（ALI）是一种常见的血管外科急症，其发病率和死亡率都很高。本研究的目的是评估美国医疗保险人群中ALI的发病率、治疗方法以及相关死亡率和截肢率的当代趋势。
这是一项利用1998年至2009年医疗保险索赔数据进行的观察性研究。所检查的结果包括ALI发病率的趋势；ALI干预措施的趋势；以及截肢、死亡率和无截肢生存率的趋势。
1998年至2009年期间，ALI住院发病率从每10万人45.7例降至每10万人26.0例（趋势P值<0.001）。接受手术干预的患者比例从57.1%降至51.6%（趋势P值<0.001），而接受血管内干预的患者比例从15.0%增至33.1%（趋势P值<0.001）。住院死亡率从12.0%降至9.0%（趋势P值<0.001），而1年死亡率保持稳定，分别为41.0%和42.5%（趋势P值无统计学意义）。住院截肢率保持稳定，分别为8.1%和6.4%（趋势P值无统计学意义），而1年截肢率从14.8%降至11.0%（趋势P值<0.001）。ALI住院后的住院无截肢生存率从81.2%增至85.4%（趋势P值<0.001）；然而，1年无截肢生存率保持不变。
1998年至2009年期间，美国医疗保险人群中ALI的发病率显著下降，采用血管内技术治疗的患者比例显著增加。在此期间，1年截肢率下降。此外，虽然ALI发病后的住院死亡率下降，但1年死亡率保持不变。
