Vascular Medicine Outcomes (VAMOS) Research Group, Department of Internal Medicine, Cardiovascular Medicine Section, Yale University, New Haven, CT, USA.
University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
Vasc Med. 2022 Aug;27(4):350-357. doi: 10.1177/1358863X221098097. Epub 2022 May 23.
Patients with critical limb ischemia (CLI) can undergo endovascular peripheral vascular intervention (PVI) to restore blood flow and decrease risk of amputation. As a potential indicator of quality for CLI care, we sought to describe 30-day major amputation rates following PVI. We also examined rate variability, and patient-level and site-level factors predicting amputations, using a national electronic health record (EHR) database. Using the Cerner Health Facts de-identified EHR database, patients with CLI diagnosis codes undergoing PVI were identified. The rate of amputation within 30 days of PVI was calculated. Risk ratios predicting amputation were derived using a mixed effects Poisson regression model adjusting for 16 patient and clinical factors. Median risk ratios (MRRs) were calculated to quantify site-level variability in amputations. A total of 20,204 PVI procedures for CLI from 179 healthcare sites were identified. Mean age at procedure was 69.0 ± 12.6 years, 58.0% were male, and 29.6% were persons of color. Amputation within 30 days of PVI occurred after 570 (2.8%) procedures. Malnutrition, previous amputation, diabetes, and being of Black race were predictors of amputation. Amputation rates across sites ranged from 0.0% to 10.0%. The unadjusted MRR was 1.40 (95% CI 1.35-1.46), which was attenuated after adjusting for patient-level factors (MRR 1.30, 95% CI 1.26-1.34) and site characteristics (MRR 1.11, 95% CI 1.09-1.13). Among PVI procedures for CLI treatment, 30-day amputation rates varied across institutions. Although patient-level factors explained some variability, site-level factors explained most variation in the rates of these outcomes.
患有严重肢体缺血（CLI）的患者可以接受血管内外周血管介入（PVI）治疗以恢复血流并降低截肢风险。作为 CLI 护理质量的潜在指标，我们旨在描述 PVI 后 30 天内的主要截肢率。我们还使用国家电子健康记录（EHR）数据库检查了截肢率的变异性以及预测截肢的患者水平和站点水平因素。
使用 Cerner Health Facts 去识别 EHR 数据库，确定了有 CLI 诊断代码并接受 PVI 的患者。计算了 PVI 后 30 天内的截肢率。使用混合效应泊松回归模型，根据 16 个患者和临床因素调整了预测截肢的风险比。计算了中位数风险比（MRR），以量化站点水平的截肢变异性。
共确定了来自 179 个医疗保健站点的 20204 例 CLI 的 PVI 手术。手术时的平均年龄为 69.0±12.6 岁，58.0%为男性，29.6%为有色人种。280 例（1.4%）PVI 术后 30 天内发生截肢。营养不良、既往截肢、糖尿病和黑人种族是截肢的预测因素。各个站点的截肢率范围为 0.0%至 10.0%。未调整的 MRR 为 1.40（95%CI 1.35-1.46），在调整患者水平因素（MRR 1.30，95%CI 1.26-1.34）和站点特征（MRR 1.11，95%CI 1.09-1.13）后减弱。
在 CLI 治疗的 PVI 手术中，各个机构的 30 天内截肢率有所不同。尽管患者水平因素解释了部分变异性，但站点水平因素解释了这些结果的发生率的大部分变化。
