Leg Amputations Among Texans Remote From Experienced Surgical Care

Area of Science:

• Vascular Surgery
• Health Services Research
• Geospatial Health Analysis

Background:

• Surgical outcomes can vary based on hospital volume and experience.
• Peripheral artery disease (PAD) and its foot complications necessitate surgical intervention, with outcomes potentially differing between experienced and low-volume centers.

Purpose of the Study:

• To characterize remote patients (living >50 miles from an experienced center) undergoing leg amputation for PAD foot complications.
• To identify geographic areas in Texas with a high concentration of such remote patients.

Main Methods:

• Analysis of Texas hospitalization data (2004-2009) for leg amputations due to PAD foot complications.
• Geocoding to determine patient remoteness and distance to care, comparing low-volume vs. experienced hospitals.

Main Results:

• 18.6% of leg amputations were on remote patients; these patients were more often white and had Medicare/Medicaid.
• Remote patients at low-volume hospitals were older, less often Hispanic, more frequently had Medicaid, and had higher rates of foot infection.
• Geospatial analysis revealed five key geographic areas with concentrated remote patient populations.

Conclusions:

• Hospital choice for remote PAD patients may be influenced or limited by travel distance.
• Future efforts to reduce leg amputations in remote populations should focus on the identified high-need geographic areas in Texas.