Barshes Neal R, Sharath Sherene, Zamani Nader, Smith Kenneth, Serag Hani, Rogers Selwyn O
Division of Vascular Surgery and Endovascular Therapy, Michael E. Debakey Department of Surgery, Baylor College of Medicine / Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
Please address correspondence to: Neal R. Barshes, M.D., M.P.H., Assistant Professor of Surgery, Division of Vascular and Endovascular Surgery, Michael E. Debakey Department of Surgery, Baylor College of Medicine / Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard (OCL 112), Houston, Texas 77030, ,
Tex Public Health J. 2018 Summer;70(3):22-27.
The existence of racial and ethnic disparities in leg amputations rates is well documented. Despite this, approaches to addressing these alarming disparities have been hampered by the inability to identify at-risk individuals in a region and design targeted interventions. We undertook this study to identify small geographic areas in which efforts focused on high-risk individuals with peripheral artery disease (PAD) could address disparities in leg amputation rates.
We used de-identified Texas state admission data to identify PAD-related admissions associated with an initial revascularization (leg angioplasty or leg bypass) or an primary leg (above-ankle) amputation between from 2004 through 2009.
21,273 major initial procedures were performed in Texas from 2004 through 2009 for PAD-related diagnoses, including 16,898 revascularizations and 4,375 leg amputations. A multivariate logistic regression demonstrated that an initial leg amputations done without revascularization was significantly associated with, among other variables: people categorized as black (odds ratio [OR] 1.79) or Hispanic (OR 1.42); those with Medicaid coverage (OR 1.89); and those treated at low volume hospitals (OR 1.78; p<0.001 for all). Four geographic regions were identified with significantly higher risk-adjusted leg amputation rates. Of the 349 Texas hospitals performing major procedures, 72 (21%) reported no revascularization procedures during the six year period studied.
Prevention efforts directed at specific geographic areas may be more likely to reach at-risk people with PAD and thereby reduce leg amputations disparities in Texas. Such efforts might also find strategies to direct patients toward higher volume centers with higher revascularization rates.
腿部截肢率存在种族和民族差异，这一点已有充分记录。尽管如此，由于无法在一个地区识别出高危个体并设计针对性干预措施，解决这些惊人差异的方法受到了阻碍。我们开展这项研究，以确定一些小地理区域，在这些区域针对外周动脉疾病（PAD）高危个体开展的工作可以解决腿部截肢率的差异问题。
我们使用了经过去识别化处理的得克萨斯州住院数据，以确定2004年至2009年间与首次血运重建（腿部血管成形术或腿部搭桥术）或初次腿部（踝关节以上）截肢相关的PAD相关住院病例。
2004年至2009年期间，得克萨斯州针对PAD相关诊断进行了21,273例主要的初次手术，包括16,898例血运重建手术和4,375例腿部截肢手术。多因素逻辑回归分析表明，在未经血运重建的情况下进行初次腿部截肢与以下因素显著相关：被归类为黑人（优势比[OR]1.79）或西班牙裔（OR 1.42）的人群；有医疗补助覆盖的人群（OR 1.89）；以及在手术量较低的医院接受治疗的人群（OR 1.78；所有p<0.001）。确定了四个地理区域，其风险调整后的腿部截肢率显著更高。在进行主要手术的349家得克萨斯州医院中，72家（21%）报告在研究的六年期间没有进行血运重建手术。
针对特定地理区域的预防工作可能更有可能惠及PAD高危人群，从而减少得克萨斯州腿部截肢的差异。此类工作还可能找到策略，引导患者前往血运重建率更高的手术量大的中心。
