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 PS116. Major Limb Amputation is Higher in Regions with Limited Access to Cardiovascular Specialists

‚ÄčKatharine L. McGinigle1, Peter J. Leese3, Thomas C. Ricketts2, William A. Marston1
1Department of Surgery, University of North Carolina, Chapel Hill, NC; 2Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC; 3Department of Performance Improvement and Patient Safety, University of North Carolina Healthcare, Chapel Hill, NC.

OBJECTIVES: To analyze the rate of major limb amputations in North Carolina in relation to physician density and comorbidities including diabetes (DM), end stage renal disease (ESRD), peripheral vascular disease (PVD), and lower extremity ulcers.

METHODS: Using the NC Hospital Inpatient Discharge Database, the rate of hospital discharges with DM, ESRD, PVD, lower extremity ulcer, or major amputation from 2006-2009 was calculated. The NC Health Professions Data System was used to define cardiovascular specialist (CVS; surgeons, cardiologists, nephrologists, radiologists) by county from 2006-2009. Counties were designated as urban or nonurban as defined by the U.S. Office of Management and Budget.

RESULTS: From 2006-2009, the rate of patients hospitalized with comorbidities increased but major amputation decreased (Table). Total major amputations decreased from 2,476 to 2,160 per year. Amputation rates decreased in both urban and nonurban counties. However, no CVS worked in 43% of nonurban counties in 2006-2009. Counties achieving fewer amputations had a higher frequency of CVS (67%) than counties experiencing an increased number of amputations (36%).

CONCLUSIONS: Despite a more acute patient population in NC, major limb amputations have decreased. However, there are underserved areas in the state that have not seen this decline. This data suggests that access to CVS is related to limb preservation.

AUTHOR DISCLOSURES: P. J. Leese, Nothing to disclose; W. A. Marston, Nothing to disclose; K. L. McGinigle, Nothing to disclose; T. C. Ricketts, Nothing to disclose.

Table: Rate of hospitalization based on condition (per 1,000 discharges)

Diagnosis
Rate in 2006
Rate in 2009
Diabetes
186
192
ESRD
24
27
PVD
20
21
Lower extremity ulcer
11
11
Major Amputation
2.45
2.10

 

Posted April 2012

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