Socioeconomic and hospital-related predictors of amputation for critical limb ischemia
Socioeconomic and hospital-related predictors of amputation for critical limb ischemia
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DOI：
10.1016/j.jvs.2010.08.077
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发表时间：
2011-02-01
影响因子：
4.3
通讯作者：
Nguyen, Louis L.
中科院分区：
文献类型：
--
作者：
Henry, Antonia J.;Hevelone, Nathanael D.;Nguyen, Louis L.
目的：保肢手术的差异可能是由社会经济地位（SES）和进入大容量医院的机会造成的。我们试图确定严重肢体缺血 (CLI) 情况下与大截肢相关的 SES 因素。方法：对 2003-2007 年全国住院患者样本进行查询，以了解包含下肢血运重建 (LER) 或大截肢和慢性 CLI 的出院情况 (N = 958,120)。 Elixhauser 方法用于调整合并症。将双变量逻辑回归中的显着预测因子输入到截肢与 LER 因变量的多变量逻辑回归中。结果：总体而言，24.2% 的 CLI 患者接受了截肢。在 SES 因素（包括种族、收入和保险状况）的双变量和多变量分析中，两组之间存在显着差异。低收入患者更有可能在低 LER 容量的机构接受治疗（比值比 [OR]，1.74；P < .001）。 LER 容量较大的中心 (OR, 15.16; P < .001) 择期入院 (OR, 2.19; P < .001) 并通过诊断影像评估 (OR, 10.63; P < .001) 的患者更有可能接受 LER。结论：在控制合并症后，少数患者、SES 较低的患者和享受医疗补助的患者更有可能因 CLI 接受截肢在低流量医院。解决 SES 和医院因素可能会降低 CLI 的截肢率。 (J Vasc Surg 2011；53:330-9。)
Objective: Disparities in limb salvage procedures may be driven by socioeconomic status (SES) and access to high-volume hospitals. We sought to identify SES factors associated with major amputation in the setting of critical limb ischemia (CLI).Methods: The 2003-2007 Nationwide Inpatient Sample was queried for discharges containing lower extremity revascularization (LER) or major amputation and chronic CLI (N = 958,120). The Elixhauser method was used to adjust for comorbidities. Significant predictors in bivariate logistic regression were entered into a multivariate logistic regression for the dependent variable of amputation vs LER.Results: Overall, 24.2% of CLI patients underwent amputation. Significant differences were seen between both groups in bivariate and multivariate analysis of SES factors, including race, income, and insurance status. Lower-income patients were more likely to be treated at low-LER-volume institutions (odds ratio [OR], 1.74; P < .001). Patients at higher-LER-volume centers (OR, 15.16; P < .001) admitted electively (OR, 2.19; P < .001) and evaluated with diagnostic imaging (OR, 10.63; P < .001) were more likely to receive LER.Conclusions: After controlling for comorbidities, minority patients, those with lower SES, and patients with Medicaid were more likely receive amputation for CLI in low-volume hospitals. Addressing SES and hospital factors may reduce amputation rates for CLI. (J Vasc Surg 2011;53:330-9.)