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Variation and Trends in Lower Extremity Amputation Rates in Los Angeles County Hospitals 2000-2010.

Ayad Jindeel1, Charles Gessert2, Brian P Johnson2

  • 1Essentia Health Department of Vascular Surgery and Medicine, Duluth, MN, USA aj1med@aol.com.

The International Journal of Lower Extremity Wounds
|June 24, 2016
PubMed
Summary

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Lower extremity amputation (LEA) rates vary significantly between hospitals, with municipal facilities showing increased rates while others declined. This disparity highlights the need for improved LEA prevention strategies across healthcare systems.

Area of Science:

  • Vascular Surgery
  • Public Health
  • Health Services Research

Background:

  • Lower extremity amputation (LEA) is a serious complication of diabetes and peripheral vascular disease.
  • Hospital-related factors like low revascularization volume and rural, non-teaching status are linked to higher LEA rates.

Purpose of the Study:

  • To analyze trends and disparities in LEA rates across Los Angeles County healthcare systems and hospitals from 2000-2010.
  • To identify variations in LEA rates by hospital type and changes over time.

Main Methods:

  • Utilized hospital discharge data from the California Office of Statewide Health Planning and Development (2000-2010).
  • Adjusted LEA rates for clinical (diabetes, PVD) and demographic factors (age, sex, race, payment source).
  • Analyzed LEA rate changes by hospital category (municipal, nonprofit, Kaiser, private) and individual hospital performance.
Keywords:
amputationhospitalprevention

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Main Results:

  • LEA rates increased in municipal hospitals but decreased in nonprofit, Kaiser, and private hospitals over the study period.
  • Significant variability (7.5-fold) in adjusted LEA relative risk was observed across hospitals, both within and between types.
  • 41 of 84 hospitals had higher-than-average LEA risk in 2007-2010, with 29 failing to reduce rates comparably to the county average.

Conclusions:

  • Healthcare systems and hospitals exhibit significant disparities in LEA rates, influenced by socioeconomic and geographic factors.
  • Variability in LEA reduction efforts among hospitals suggests opportunities for targeted quality improvement initiatives.
  • Addressing systemic and hospital-specific factors is crucial for reducing preventable lower extremity amputations.