The effect of risk and race on lower extremity amputations among Medicare diabetic patients
The effect of risk and race on lower extremity amputations among Medicare diabetic patients
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DOI：
10.1016/j.jvs.2012.05.100
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发表时间：
2012-12-01
影响因子：
4.3
通讯作者：
Baker, Frank
中科院分区：
文献类型：
--
作者：
Goldberg, Joshua B.;Goodney, Philip P.;Baker, Frank
目的：旨在限制糖尿病患者下肢截肢的国家质量倡议的效果仍不确定。因此，我们探讨了医疗保险糖尿病患者截肢的趋势，重点关注那些风险最高的患者。方法：采用糖尿病分析档案，从医保5%样本中抽取所有糖尿病患者作为强化样本，对全国糖尿病患者截肢发生率进行研究。在1999年至2006年期间，我们对500万糖尿病患者进行了队列研究，比较了高风险（终末期肾脏疾病或超过三种合并症）和低风险组以及种族的截肢发生率。结果：1999年至2006年间，共进行了23,976例截肢手术，其中11,558例为高危患者，12,418例为低危患者。截肢率从1999年的4.8/1000下降到2006年的4.4/1000 （P < 0.001）。高危患者在所有截肢患者中所占的比例越来越大（1999年为33%，2006年为50%；P < 0.001），尽管在1999年和2006年分别占糖尿病患者的4%和10% （P < 0.001）。高危组截肢发生率为29.6/1000，低危组为2.7/1000 （P < 0.001）。非裔美国人在高风险和低风险人群中截肢率更高。结论：高风险患者只占医保糖尿病患者的少数，但却占所有截肢患者的50%，这种影响在非裔美国人中被放大。未来的质量改进工作应该集中在高危患者和非裔美国人身上。（中华外科杂志2012；56:1663-8）
Objective: The effect of national quality initiatives aiming at limiting lower extremity amputations in diabetic patients remains uncertain. We therefore explored trends in amputation among Medicare diabetic patients with a focus on those at highest risk.Methods: The Diabetes Analytical File, an enhanced sample of all diabetic patients from the Medicare 5% sample, was used to study the national incidence of amputation in diabetic patients. Within a cohort of similar to 5 million diabetic patients between 1999 and 2006, we compared the incidence of amputation in high-risk (end-stage renal disease or more than three comorbidities) and low-risk groups and by race.Results: Between 1999 and 2006, 23,976 amputations were performed, comprising 11,558 in high-risk and 12,418 in low-risk patients. The amputation rate declined over time from 4.8/1000 in 1999 to 4.4/1000 in 2006 (P < .001). High-risk patients represented a growing proportion of all amputations (33% in 1999, 50% in 2006; P < .001) despite representing 4% of diabetic patients in 1999 and 10% in 2006 (P < .001). The incidence of amputation was 29.6/1000 in the high-risk group vs 2.7/1000 in low-risk patients (P < .001). African Americans had higher rates of amputation in high-risk and low-risk groups.Conclusions: High-risk patients represent a minority of Medicare diabetic patients but account for 50% of all amputations, and this effect is magnified in African Americans. Future quality improvement efforts should focus on high-risk patients and African Americans. (J Vasc Surg 2012;56:1663-8.)