Outcomes for critical limb ischemia are driven by lower extremity revascularization volume, not distance to hospital

• Published in: Journal of vascular surgery 2017-08, Vol.66 (2), p.476-487.e1
• Main Authors: Medhekar, Ankit N., BS, Mix, Doran S., MD, Aquina, Christopher T., MD, Trakimas, Lauren E., DO, Noyes, Katia, PhD, Fleming, Fergal J., MBBCh, Glocker, Roan J., MD, Stoner, Michael C., MD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Amputation; Catchment Area (Health); Chi-Square Distribution; Critical Illness; Female; Health Services Accessibility; Healthcare Disparities; Hospitals, High-Volume; Hospitals, Low-Volume; Humans; Ischemia - diagnostic imaging; Ischemia - mortality; Ischemia - physiopathology; Ischemia - surgery; Limb Salvage; Logistic Models; Lower Extremity - blood supply; Male; Middle Aged; Multivariate Analysis; New York; Odds Ratio; Peripheral Arterial Disease - diagnostic imaging; Peripheral Arterial Disease - mortality; Peripheral Arterial Disease - physiopathology; Peripheral Arterial Disease - surgery; Postal Service; Process Assessment (Health Care); Retrospective Studies; Risk Factors; Socioeconomic Factors; Surgery; Time Factors; Treatment Outcome; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - mortality
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2017.01.062

Abstract Objective The objective of this study was to identify relationships among geographic access to care, vascular procedure volume, limb preservation, and survival in patients diagnosed with critical limb ischemia (CLI). Methods Using New York State administrative data from 2000 to 2013, we identified a patient's first presentation with CLI defined by International Classification of Diseases, Ninth Revision diagnosis and procedure codes. Distance from the patient's home to the index hospital was calculated using the centroids of the respective ZIP codes. A multivariable logistic regression model was employed to estimate the impact of distance, major lower extremity amputation (LEA) volume, and lower extremity revascularization (LER) volume on major amputation and 30-day mortality. Volumes and distances were analyzed in quintiles. The farthest distance quintile and the highest procedure volume quintiles were used as references for generating odds ratios (ORs). Results There were 49,576 patients identified with an initial presentation of CLI. The median age was 73 years, 35,829 (73.2%) had Medicare as a primary insurer, 11,395 (23.0%) had a major amputation, and 4249 (8.6%) died within 30 days of admission. Patients in the closest distance quintile were more likely to undergo amputation (OR, 1.53 [1.39-1.68]; P