Qureshi Fahad, Amundson Rachel, Singh Som P, Pitchyaiah Prathi, Ramprasad Aarya, Surucu Serkan
School of Medicine, University of Missouri-Kansas City, Kansas City, USA.
Division of Nephrology and Hypertension, The Mayo Clinic, Rochester, USA.
Cureus. 2022 Jan 20;14(1):e21455. doi: 10.7759/cureus.21455. eCollection 2022 Jan.
Peripheral artery disease (PAD) signifies the obstruction of blood vessels in the lower extremities due to harmful buildup of fatty material. Patients may present to their primary care provider complaining of lower extremity pain, especially during exercise. Primary care providers must weigh the severity of patients' disease process to determine if an orthopedic surgery referral is needed based on an extensive history as well as analysis of demographic factors that may influence their risk of morbidity and mortality. We aimed to objectively present these demographic factors with numeric values in terms of influence.
We utilized the Cerner Health Facts database to analyze 63 million unique patient encounters from 2000 to 2018. The database is categorized as Institutional Review Board (IRB) exempt due to its de-identified presentation. In an outcome-based approach, we were able to calculate referral patterns based on entered demographic parameters.
A patient's age, census region, marital status, previous history of PAD/critical limb ischemia (CLI), history of surgeries, race, facility type, and urban/rural status presented as predictors of seeing a surgeon during a patient encounter.
Our results found numerous aforementioned demographic factors to be associated with orthopedic surgery referral patterns. This is significant as proper reconciliation of these factors may help reduce patient morbidity in terms of amputation reduction and reduce patient mortality associated with this surgery or complications.
外周动脉疾病(PAD)意味着下肢血管因脂肪物质的有害堆积而阻塞。患者可能会向他们的初级保健提供者抱怨下肢疼痛,尤其是在运动期间。初级保健提供者必须权衡患者疾病进程的严重程度,以便根据详尽的病史以及对可能影响其发病和死亡风险的人口统计学因素的分析,来确定是否需要转诊至骨科进行手术。我们旨在用数值客观地呈现这些人口统计学因素的影响。
我们利用Cerner健康事实数据库分析了2000年至2018年的6300万次独特患者就诊情况。该数据库因其去识别化呈现而被归类为机构审查委员会(IRB)豁免。采用基于结果的方法,我们能够根据输入的人口统计学参数计算转诊模式。
患者的年龄、人口普查地区、婚姻状况、既往外周动脉疾病/严重肢体缺血(CLI)病史、手术史、种族、医疗机构类型以及城乡状况,均表现为患者就诊期间看外科医生的预测因素。
我们的研究结果发现,上述众多人口统计学因素与骨科手术转诊模式相关。这具有重要意义,因为对这些因素进行适当梳理可能有助于降低患者截肢方面的发病率,并降低与此手术或并发症相关的患者死亡率。