Abstract
The objective of this study was to investigate if the insurance status of patients impacted the treatment options and prognosis in acute limb ischemia (ALI). A retrospective chart review was performed at a single university tertiary care center using ICD-9 codes for the diagnosis and procedure for ALI from January 2000 to January 2011. A total of 96 patients were diagnosed with ALI, comprising of 66 males and 30 females with a mean age of 56 years (range was 19 - 80 years). Time to presentation and prognosis (rate and level of amputation) were analyzed using insurance status as the independent variable. Patients covered under commercial insurance were compared to patients with Medicare and Medicaid and to patients without any insurance coverage. Statistical analysis was performed using the proportion z test to evaluate differences among the groups investigated. A “p” value of ≤0.05 was considered significant. In this study, ALI occurred more commonly in African Americans (p = 0.0029) and in patients without insurance coverage regardless of race (p = 0.0034). Chronic obstructive pulmonary disease (COPD), hypertension (HTN), and acute renal failure (ARF) were significantly higher in the uninsured group, compared to the insured group (p = 0.0005, 0.0055, and 0.0034, respectively). The time to hospital admission was significantly longer in uninsured patients compared to the insured group (p = 0.0449). The rates of major amputation above the ankle were 46% in patients with commercial insurance, 62% in the government insurance (Medicare and Medicaid) group, and 51% in the uninsured group. There was no significant difference in major versus minor amputation in patients with commercial insurances. However, the rates of major amputation were significantly higher than the rates of minor amputation in both Medicare and Medicaid and uninsured patients (p = 0.005, and <0.0001, respectively). With respect to acute lower limb ischemia, African Americans presented more frequently and were more likely to be uninsured. The incidences of COPD, HTN, and ARF were significantly higher in uninsured patients. The majority of the amputations in Medicare and Medicaid and uninsured populations were likely above the ankle. Results suggest that government insurance coverage does not prevent major amputation in patients with ALI.
Highlights
In the current climate of health care reform in general and the Affordable Healthcare Act in particular, it is appropriate to look at insurance status on the prognosis of vascular disease [1]-[4]
We reviewed the charts of patients with Acute limb ischemia (ALI) with an emphasis on their insurance status
It was seen that chronic obstructive pulmonary disease (COPD), hypertension (HTN), and acute renal failure (ARF) were significantly higher in the uninsured group compared to the insured (p = 0.0005, 0.0055, and 0.0034, respectively)
Summary
In the current climate of health care reform in general and the Affordable Healthcare Act in particular, it is appropriate to look at insurance status on the prognosis of vascular disease [1]-[4]. Acute limb ischemia (ALI) is a serious condition where there is a sudden decrease in limb perfusion causing a potential threat to limb viability manifested by ischemic rest pain, ischemic ulcers, and/or gangrene [5]. Patients who present more than two weeks after the onset of the acute event are considered to have chronic limb ischemia. Management of acute arterial occlusion has remained as a challenge for vascular specialists. Thrombolytic therapy and percutaneous transluminal angioplasty (PTA) became treatment options for selected patients [7] [8]. Despite these advances, morbidity and mortality, and the rates of limb loss from ALI remain high [9]. Regardless of the treatment modality used, early diagnosis and rapid initiation of therapy are essential in order to salvage the ischemic extremity
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