Racial differences in primary and repeat lower extremity amputation: Results from a multihospital study
Racial differences in primary and repeat lower extremity amputation: Results from a multihospital study
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DOI：
10.1016/j.jvs.2005.01.040
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发表时间：
2005-05-01
影响因子：
4.3
通讯作者：
Pearce, WH
中科院分区：
文献类型：
--
作者：
Feinglass, J;Rucker-Whitaker, C;Pearce, WH
目的：与白人患者相比，非洲裔美国人下肢截肢（膝盖以上或膝盖以下）的风险要高得多，肢体保留血管手术或血管成形术的比例要低得多。本文分析了种族差异的两种潜在途径：原发性截肢，定义为没有事先进行任何血运重建尝试的大截肢，以及重复截肢，定义为在先前的全足或大截肢之后进行的大截肢。随机选择的248名非裔美国人、30名西班牙裔美国人和235名白人或其他种族患者的医疗记录在1995年至2003年期间在芝加哥三家教学医院接受了膝盖以上或以下的截肢手术。慢性疾病患病率和严重程度、入院前功能状态、临床表现和血管病史被用来检验种族和民族对初次和重复截肢率的风险调整效应。在控制人口统计学、功能、慢性疾病和临床特征的情况下，非洲裔美国患者接受原发性截肢（P = 0.01）和重复截肢（P = 0.03）的可能性是白人或其他种族截肢者的1.7倍。即使在控制了非裔美国截肢者较高的疾病严重程度、更大的残疾程度和更复杂的表现之后，种族仍然是一个重要的独立风险因素。在研究医院中，非裔美国患者的初级和重复截肢率更高，这些医院都有重要的血管手术能力和积极的肢体保留政策，这表明这些比率在设备不太完善的机构中可能更高。改善低收入患者获得初级和预防性护理的机会可以降低非洲裔美国人的截肢率。
Objective: African Americans have a much higher risk of major (above- or below-knee) lower extremity amputation and a lower rate of limb-preserving vascular surgery or angioplasty than white patients. This article analyzes two potential pathways for racial disparities: primary amputation, defined as a major amputation performed without any prior attempt at revascularization, and repeat amputation, defined as a major amputation subsequent to a previous through-foot or major amputation.Methods. Randomly selected medical records were reviewed for 248 African American, 30 Hispanic, and 235 white or other-race patients undergoing above- or below-knee amputation between 1995 and 2003 at three Chicago teaching hospitals. Chronic disease prevalence and severity, preadmission functional status, clinical presentation, and vascular history were used to test the risk-adjusted effect of race and ethnicity on rates of primary and repeat amputation.Results. Controlling for demographic, functional, chronic disease, and clinical characteristics, African American patients were 1.7 times more likely to have undergone both primary (P = .01) and repeat (P = .03) amputation than white or other-race amputees. Race remained a significant independent risk factor even after controlling for the higher severity of illness, greater disability, and more complex presentation of African American amputees.Conclusions. Higher rates of primary and repeat amputation for African American patients at study hospitals, which all have significant vascular surgery capacity and an aggressive policy of limb salvage, suggest that these rates may be even higher at less well equipped institutions. Improving access to primary and preventive care for lower-income patients could reduce amputation rates among African Americans.