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High mortality risks after major lower extremity amputation in Medicare patients with peripheral artery disease.

Publication ,  Journal Article
Jones, WS; Patel, MR; Dai, D; Vemulapalli, S; Subherwal, S; Stafford, J; Peterson, ED
Published in: Am Heart J
May 2013

BACKGROUND: Little is known regarding the contemporary outcomes of older patients with peripheral artery disease (PAD) undergoing major lower extremity (LE) amputation in the United States. We sought to characterize clinical outcomes and factors associated with outcomes after LE amputation in patients with PAD. METHODS: Using data from the Centers for Medicare and Medicaid Services from January 1, 2000, to December 31, 2008, we examined the national patterns of mortality after major LE amputation among patients 65 years or older with PAD. Cox proportional hazards models were used to investigate the association between clinical variables, comorbid conditions, year of index amputation, geographic variation, and major LE amputation. RESULTS: Among 186,338 older patients with identified PAD who underwent major LE amputation, the mortality rate was 13.5% at 30 days, 48.3% at 1 year, and 70.9% at 3 years. Age per 5-year increase (hazard ratio [HR] 1.29, 95% CI 1.29-1.29), history of heart failure (HR 1.71, 95% CI 1.71-1.72), renal disease (HR 1.84. 95% CI 1.83-1.85), cancer (HR 1.71, 95% CI 1.70-1.72), and chronic obstructive pulmonary disease (HR 1.33, 95% CI, 1.32-1.33) were all independently associated with death after major LE amputation. Subjects who underwent above knee amputation had a statistically higher hazard of death when compared with subjects who underwent LE amputation at more distal locations (HR with above the knee amputation 1.31, 95% CI 1.25-1.36). CONCLUSIONS: Older patients with PAD undergoing major LE amputation still face a slightly high mortality risk, with almost half of all patients with PAD dying within a year of major LE amputation.

Duke Scholars

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

May 2013

Volume

165

Issue

5

Start / End Page

809 / 815.e1

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Survival Rate
  • Risk Factors
  • Risk Assessment
  • Registries
  • Proportional Hazards Models
  • Peripheral Arterial Disease
  • Medicare
 

Citation

APA
Chicago
ICMJE
MLA
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Jones, W. S., Patel, M. R., Dai, D., Vemulapalli, S., Subherwal, S., Stafford, J., & Peterson, E. D. (2013). High mortality risks after major lower extremity amputation in Medicare patients with peripheral artery disease. Am Heart J, 165(5), 809-815.e1. https://doi.org/10.1016/j.ahj.2012.12.002
Jones, W Schuyler, Manesh R. Patel, David Dai, Sreekanth Vemulapalli, Sumeet Subherwal, Judith Stafford, and Eric D. Peterson. “High mortality risks after major lower extremity amputation in Medicare patients with peripheral artery disease.Am Heart J 165, no. 5 (May 2013): 809-815.e1. https://doi.org/10.1016/j.ahj.2012.12.002.
Jones WS, Patel MR, Dai D, Vemulapalli S, Subherwal S, Stafford J, et al. High mortality risks after major lower extremity amputation in Medicare patients with peripheral artery disease. Am Heart J. 2013 May;165(5):809-815.e1.
Jones, W. Schuyler, et al. “High mortality risks after major lower extremity amputation in Medicare patients with peripheral artery disease.Am Heart J, vol. 165, no. 5, May 2013, pp. 809-815.e1. Pubmed, doi:10.1016/j.ahj.2012.12.002.
Jones WS, Patel MR, Dai D, Vemulapalli S, Subherwal S, Stafford J, Peterson ED. High mortality risks after major lower extremity amputation in Medicare patients with peripheral artery disease. Am Heart J. 2013 May;165(5):809-815.e1.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

May 2013

Volume

165

Issue

5

Start / End Page

809 / 815.e1

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Survival Rate
  • Risk Factors
  • Risk Assessment
  • Registries
  • Proportional Hazards Models
  • Peripheral Arterial Disease
  • Medicare