In comparison to patients at the highest volume centers, patients at the lowest volume centers were at 15.2 times higher odds of undergoing major amputation. Patients in the second quartile were also at significantly increased odds of undergoing major amputation and those at hospitals in the third quartile were at 77 percent higher odds of undergoing major amputation compared to those at the highest volume.

"Our findings suggest there are gaps in access to care despite controlling for hospital level factors and procedural volume," added Dr. Nguyen. "Addressing SES, hospital factors and the inverse relationship between LER procedure volume and risk of major amputation for CLI, highlights potential solutions for disparities related to hospital-level factors. Also increasing state and local funding to facilities that provide care to patients at high risk for major amputation may improve professional resources."

Dr. Nguyen added that further analysis of datasets that contain information on referral patterns and utilization of outpatient health care could guide potential interventions which target patients at high risk for PAD and major amputation. He noted that this information also could lead the way for implementing screening protocols focused on risk factor modification and appropriate early vascular surgery referral pathways.

"Given the highly positive impact of preoperative angiography on the likelihood of undergoing a LER procedure, studying the factors influencing the clinical decision to evaluate revascularization options may illustrate reasons for the less frequent use of angiography in certain patient populations and help to more widely implement standard diagnostic protocols," concluded Dr. Nguyen. "Further exploration of these potential mechanisms of disparities both at the patient and the hospital levels may improve limb salvage for the vulnerable population."

Source:  Journal of Vascular Surgery