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 ∼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.
OBJECTIVE: The effect of national quality initiatives aiming at limiting lower extremity amputations in diabeticpatients remains uncertain. We therefore explored trends in amputation among Medicare diabeticpatients with a focus on those at highest risk. METHODS: The Diabetes Analytical File, an enhanced sample of all diabeticpatients from the Medicare 5% sample, was used to study the national incidence of amputation in diabeticpatients. Within a cohort of ∼5 million diabeticpatients 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 diabeticpatients 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 diabeticpatients 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.
Authors: Chin-Lin Tseng; Mangala Rajan; Donald R Miller; Gerald Hawley; Stephen Crystal; Minge Xie; Anjali Tiwari; Monika Safford; Leonard Pogach Journal: Med Care Date: 2005-01 Impact factor: 2.983
Authors: J Feinglass; W H Pearce; G J Martin; J Gibbs; D Cowper; M Sorensen; W G Henderson; J Daley; S Khuri Journal: Surgery Date: 2001-07 Impact factor: 3.982
Authors: Arleen F Brown; Edward W Gregg; Mark R Stevens; Andrew J Karter; Morris Weinberger; Monika M Safford; Tiffany L Gary; Dorothy A Caputo; Beth Waitzfelder; Catherine Kim; Gloria L Beckles Journal: Diabetes Care Date: 2005-12 Impact factor: 19.112
Authors: William H van Houtum; Jan A Rauwerda; Dirk Ruwaard; Nicolaas C Schaper; Karel Bakker Journal: Diabetes Care Date: 2004-05 Impact factor: 19.112
Authors: Andres Schanzer; Jessica Mega; Judith Meadows; Russell H Samson; Dennis F Bandyk; Michael S Conte Journal: J Vasc Surg Date: 2008-12 Impact factor: 4.268
Authors: Chin-Lin Tseng; Mangala Rajan; Donald R Miller; Jean-Philippe Lafrance; Leonard Pogach Journal: Diabetes Care Date: 2011-03-16 Impact factor: 19.112
Authors: Bjoern D Suckow; Karina A Newhall; Kimon Bekelis; Adrienne E Faerber; Daniel J Gottlieb; Jonathan S Skinner; David H Stone; Philip P Goodney Journal: Ann Vasc Surg Date: 2016-07-27 Impact factor: 1.466
Authors: Jeff Y Yang; Tiansheng Wang; Virginia Pate; Emily W Gower; Matthew J Crowley; John B Buse; Til Stürmer Journal: Diabetes Obes Metab Date: 2019-03-04 Impact factor: 6.577
Authors: Caitlin W Hicks; Shalini Selvarajah; Nestoras Mathioudakis; Bruce A Perler; Julie A Freischlag; James H Black; Christopher J Abularrage Journal: J Vasc Surg Date: 2014-06-14 Impact factor: 4.268
Authors: Benjamin S Brooke; Larry W Kraiss; David H Stone; Brian Nolan; Randall R De Martino; Gayle E Reiber; David C Goodman; Jack L Cronenwett; Philip P Goodney Journal: Ann Vasc Surg Date: 2014-06-06 Impact factor: 1.466