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 Risks and Race in Lower Extremity Amputations in Medicare Diabetic Patients Studied

December 1, 2012    Contact: Sue Patterson    970-213-8218                              
CHICAGO - A new study published in the December 2012 issue of the Journal of Vascular Surgery® examines the effect of risk and race on lower extremity amputation among Medicare diabetic patients. Lead author, Joshua B. Goldberg, MD, from the Department of Surgery at Dartmouth-Hitchcock Medical Center in Lebanon, NH, analyzed a large cohort of Medicare patients with diabetes. 

 Dr. Goldberg found that while lower extremity amputation rates are falling overall, amputation rates are actually rising in high risk patients – such as those with multiple medical problems and among African Americans. “In a time when effective and efficient healthcare is a priority, this study identifies where quality improvement efforts will matter most,” he said.

 Among the  23,976 amputations analyzed over the eight-year study period,  almost half (48 percent, 11,558)  of the patients were categorized as high risk (defined as having end-stage renal disease (ESRD) and/or greater than three comorbidities including congestive heart failure, myocardial infarction, ischemic heart disease, or chronic kidney disease). The remainder of the 12,418 amputees studied were categorized as low risk as they had less than three comorbidities.

 Researchers found African Americans experienced amputation rates that were twice as high as in their white counterparts, and this difference persisted among both high and low risk patients. Among high-risk patients, the amputations rate was 50 per 1,000 among high-risk diabetic African Americans, but and 24 per 1,000 among high-risk diabetic whites. A similar difference existed in the low-risk cohorts, with an amputation rate of six per 1,000 in African American patients, and three per 1,000 in whites. Dr. Goldberg added that while overall amputation rates among diabetics declined over the study period, amputation rates actually increased in the high risk patients and among African Americans diabetics.  The decline in the overall rate was attributable to a decline among white diabetics.  

 “Our analysis suggests that to achieve progressive and meaningful reduction in amputations among patients with diabetes, quality initiatives need to focus on high-risk groups and African Americans,” said Dr. Goldberg. “Limiting amputation risk in these groups will be difficult, however. Diabetic patients undergoing amputation are now younger, with more burden of co-morbid illness. Disparities in care between African American and white patients have complex associations including socioeconomic status and access to care. Regardless of these challenges, quality improvement and preventive efforts need to further investigated.”
About Journal of Vascular Surgery
Journal of Vascular Surgery® provides vascular, cardiothoracic and general surgeons with the most recent information in vascular surgery. Original, peer-reviewed articles cover clinical and experimental studies, noninvasive diagnostic techniques, processes and vascular substitutes, microvascular surgical techniques, angiography and endovascular management. Special issues publish papers presented at the annual meeting of the Journal's sponsoring society, the Society for Vascular Surgery®.
About the Society for Vascular Surgery
The Society for Vascular Surgery® (SVS) is a not-for-profit professional medical society, composed primarily of vascular surgeons, that seeks to advance excellence and innovation in vascular health through education, advocacy, research, and public awareness. SVS is the national advocate for 4,500 specialty-trained vascular surgeons and other medical professionals who are dedicated to the prevention and cure of vascular disease.

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