Foley Katelyn M, Kennedy Kevin F, Lima Fabio V, Secemsky Eric A, Banerjee Subhash, Goodney Philip P, Shishehbor Mehdi H, Soukas Peter A, Hyder Omar N, Abbott J Dawn, Aronow Herbert D
Lifespan Cardiovascular Institute, Warren Alpert Medical School of Brown University Providence RI.
Statistical Consultant Kansas City MO.
J Am Heart Assoc. 2024 Feb 6;13(3):e030899. doi: 10.1161/JAHA.123.030899. Epub 2024 Jan 19.
Little is known about treatment variability across US hospitals for patients with chronic limb-threatening ischemia (CLTI).
Data were collected from the 2016 to 2018 National Inpatient Sample. All patients aged ≥18 years, admitted to nonfederal US hospitals with a primary diagnosis of CLTI, were identified. Patients were classified according to their clinical presentation (rest pain, skin ulceration, or gangrene) and were further characterized according to the treatment strategy used. The primary outcome of interest was variability in CLTI treatment, as characterized by the median odds ratio. The median odds ratio is defined as the likelihood that 2 similar patients would be treated with a given modality at 1 versus another randomly selected hospital. There were 15 896 (weighted n=79 480) hospitalizations identified where CLTI was the primary diagnosis. Medical therapy alone, endovascular revascularization ± amputation, surgical revascularization ± amputation, and amputation alone were used in 4057 (25%), 5390 (34%), 3733 (24%), and 2716 (17%) patients, respectively. After adjusting for both patient- and hospital-related factors, the median odds ratio (95% CI) for medical therapy alone, endovascular revascularization ± amputation, surgical revascularization ± amputation, any revascularization, and amputation alone were 1.28 (1.19-1.38), 1.86 (1.77-1.95), 1.65 (1.55-1.74), 1.37 (1.28-1.45), and 1.42 (1.27-1.55), respectively.
Significant variability in CLTI treatment exists across US hospitals and is not fully explained by patient or hospital characteristics.
对于美国医院中慢性肢体威胁性缺血（CLTI）患者的治疗差异了解甚少。
数据收集自2016年至2018年的全国住院患者样本。确定所有年龄≥18岁、入住美国非联邦医院且主要诊断为CLTI的患者。根据临床表现（静息痛、皮肤溃疡或坏疽）对患者进行分类，并根据所采用的治疗策略进一步进行特征描述。感兴趣的主要结局是CLTI治疗的差异，以中位数优势比来表征。中位数优势比定义为两名相似患者在一家医院与另一家随机选择的医院接受特定治疗方式的可能性。共确定了15896例（加权n = 79480）以CLTI为主要诊断的住院病例。仅接受药物治疗、血管腔内血运重建±截肢、外科血运重建±截肢以及仅截肢的患者分别有4057例（25%）、5390例（34%）、3733例（24%）和2716例（17%）。在对患者和医院相关因素进行调整后，仅药物治疗、血管腔内血运重建±截肢、外科血运重建±截肢、任何血运重建以及仅截肢的中位数优势比（95%CI）分别为1.28（1.19 - 1.38）、1.86（1.77 - 1.95）、1.65（1.55 - 1.74）、1.37（1.28 - 1.45）和1.42（1.27 - 1.55）。
美国各医院在CLTI治疗方面存在显著差异，且患者或医院特征无法完全解释这种差异。
