Rate of Emergency Lower Extremity Amputations in the United States Among Medicare Beneficiaries.
Rate of Emergency Lower Extremity Amputations in the United States Among Medicare Beneficiaries.
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美国医疗保险受益人紧急下肢截肢率。
DOI：
10.1097/sla.0000000000006105
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发表时间：
2024
影响因子：
9
通讯作者：
Ibrahim,AndrewM
中科院分区：
文献类型：
--
作者：
Dualeh,ShukriHA;Powell,ChloeA;Kunnath,Nicholas;Corriere,MatthewA;Ibrahim,AndrewM
目的：确定急诊下肢截肢与选择性下肢截肢在美国的比率。背景：下肢截肢是控制不良的糖尿病和多级别周围血管疾病患者的常见终点。虽然理想情况下手术是选择性进行的，但接触受限的患者可能会在以后出现并需要紧急手术。目前尚不清楚美国各地下肢紧急截肢率的差异有多大。方法：对2015年至2020年接受下肢截肢的医疗保险受益人进行评估。为每个邮政编码确定费率，并按从最低到最高费率的顺序排列。我们使用谷歌地图应用程序编程接口将每个受益人的居住地和护理地点与美国医院协会年度调查合并，以确定患者接受手术的旅行距离。结果：233,084例患者中，男性占66.3%（154,597例），白人占69.8%（162,786例）。平均年龄（SD） 74岁（8岁）。急诊下肢截肢率差异很大。邮政编码最低的五分之一显示紧急截肢率为3.7%，而最高的五分之一显示90%。急诊手术率最低的五分位数中位出行距离为34.6英里，而急诊手术率最高的五分位数中位出行距离为10.5英里（P< 0.001）。结论：医疗保险受益人的急诊下肢截肢率差异很大，表明获得基本血管护理的机会不同。行走距离与截肢率呈反比关系，表明行走距离以外的障碍也在起作用。
Objective:To determine the rate of emergency versus elective lower extremity amputations in the United States.Background:Lower extremity amputation is a common endpoint for patients with poorly controlled diabetes and multilevel peripheral vascular disease. Although the procedure is ideally performed electively, patients with limited access may present later and require an emergency operation. To what extent rates of emergency amputation for lower extremities vary across the United States is unknown.Methods:Evaluation of Medicare beneficiaries who underwent lower extremity amputation between 2015 and 2020. The rate was determined for each zip code and placed into rank order from lowest to highest rate. We merged each beneficiary’s place of residence and location of care with the American Hospital Association Annual Survey using Google Maps Application Programming Interface to determine the travel distance for patients to undergo their procedure.Results:Of 233,084 patients, 66.3%(154,597) were men, 69.8%(162,786) were White. The average age (SD) was 74 years (8). There was wide variation in rates of emergency lower extremity amputation. The lowest quintile of zip codes demonstrated an emergency amputation rate of 3.7%, whereas the highest quintile demonstrated 90%. The median travel distance in the lowest emergency surgery rate quintile was 34.6 miles compared with 10.5 miles in the highest quintile of emergency surgery (P< 0.001).Conclusions:There is wide variation in the rate of emergency lower extremity amputations among Medicare beneficiaries, suggesting variable access to essential vascular care. Travel distance and rate of amputation have an inverse relationship, suggesting that barriers other than travel distance are playing a role.
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DOI：
--
发表时间：
1985
期刊：
Journal of immunology (Baltimore, Md. : 1950)
影响因子：
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作者：
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DOI：
10.1073/pnas.83.5.1458
发表时间：
1986
影响因子：
11.1
作者：
Lacy,J;Sarkar,SN;Summers,WC
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Summers,WC
DOI：
10.1073/pnas.83.11.3982
发表时间：
1986-06-01
影响因子：
11.1
作者：
REED, JC;ALPERS, JD;HOOVER, RG
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影响因子：
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影响因子：
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作者：
P. Nowell;C. Croce
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