PVSS12. Socioeconomic and Hospital-Related Predictors of Amputation for Critical Limb Ischemia

Abstract

Disparities in limb salvage procedures may be driven by socioeconomic status (SES) and access to high volume hospitals. We sought to identify SES factors associated with major amputation in the setting of critical limb ischemia (CLI). The 2007 Nationwide Inpatient Sample was queried for discharges containing lower extremity revascularization (LER), major amputation, and chronic CLI (N = 152, 736). The Elixhauser method was used to adjust for comorbidities. Significant predictors in bivariate logistic regression were entered into a multivariate logistic regression for the dependent variable of amputation vs LER. Overall, 18.1% of CLI patients underwent amputation. Significant differences were seen between both groups in bivariate and multivariate analysis of SES factors, including race, income, and insurance status (Table 1). Lower income patients were more likely to be treated at low LER volume institutions (OR 1.44, p = 0.017). Patients at higher LER volume centers (OR 2.11, p < 0.001), admitted electively (OR 1.96, p < 0.001) and evaluated with diagnostic imaging (OR 4.30, p < 0.001) were more likely to receive LER.Table 1Multivariate regression for amputationOdds Ratio for Amputation95% Confidence IntervalMale gender1.22 (p < 0.001)1.13, 1.32Black vs White race2.33 (p < 0.001)2.02, 2.69Hispanic vs White race1.37 (p < 0.001)1.16, 1.62Median income <\$39, 0001.25 (p = 0.005)1.08, 1.45 \$39, 000-47, 9991.11 (p = 0.159)0.96, 1.28 \$48, 000-62, 9991.03 (p = 0.682)0.88, 1.21 >\$63, 000refPrivate payer vs Medicare0.83 (p = 0.002)0.74, 0.94Medicaid vs Medicare1.24 (p = 0.015)1.04, 1.48 Open table in a new tab After controlling for comorbidities, minority patients, those with lower SES, and patients with Medicaid were more likely receive amputation for CLI in low volume hospitals. Addressing SES and hospital factors may reduce amputation rates for CLI.