A Lack of Decline in Major Amputations in the State of Texas: Temporal Trends and Impact of Revascularization

Garcia, Marlene

A Lack of Decline in Major Amputations in the State of Texas: Temporal Trends and Impact of Revascularization

Monday, May 20, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Marlene Garcia, M.D. , University of Texas Health Sciences Center at San Antonio, Shavano Park, TX

Tyler G Ellington, MD , University of Texas Health Sciences Center at San Antonio, San Antonio, TX

Joel Michalek, PhD , University of Texas Health Sciences Center at San Antonio, San Antonio, TX

Susan p fisher-Hoch, MD , University of Texas Health Science Center - Houston, School of Publich Health, Brownsville, TX

Joseph B Mccormick, MD , University of Texas Health Science Center - Houston, School of Publich Health, Brownsville, TX

Anand Prasad, M.D., FSCAI , UTHSCSA, San Antonio, TX

Background
Nationally, major non-traumatic lower extremity amputations (LEAs) are declining. Concurrently, the frequency of endovascular therapy for critical limb ischemia is rising. The purpose of this study was to evaluate major LEA and revascularization trends in the State of Texas.

Methods
Inpatient hospital discharge data was obtained from the Texas Center for Health Statistics for the years 2005-2014. The number of LEAs in Texas were determined by ICD-9 codes. LEA was defined as involving the proximal part of the foot, leg (below the knee), thigh (above the knee), and hip disarticulation. The rates of LEAs and revascularization (surgical and/or endovascular) were determined. Multivariate analyses were performed to examine the relationship between revascularization status and LEAs.

Results
Amputation rates remained stable (~250 per 100,000 admissions) over the analysis period. Revascularization (both endovascular and/or surgery) during index admission for LEA declined over time (p<0.001, Figure 1). 10.1% of all admissions for LEA had concomitant revascularization. Revascularization was associated with lower odds for LEA (OR 0.52; [CI 0.5-0.54], p<0.001).

Conclusions
Counter to national trends, LEA rates in Texas are not declining and revascularization rates during the index admission are low. Undergoing revascularization (either surgical/endovascular) were associated with lower odds for amputation. Further study of barriers to revascularization and amputation prevention in Texas is warranted.