(HealthDay News) – There are significant regional differences in spending on vascular care in patients who ultimately need amputation for severe peripheral arterial disease, according to a study published online Nov. 20 in JAMA Surgery.
Philip P. Goodney, MD, from the Dartmouth-Hitchcock Medical Center in Lebanon, NH, and colleagues retrospectively analyzed data on 18,463 U.S. Medicare patients who underwent a major peripheral arterial disease-related amputation from 2003–2010. Data were correlated to price-adjusted Medicare spending on revascularization procedures and related vascular care in the year before amputation, across hospital referral regions.
The researchers found that among patients undergoing an amputation, 64% were admitted to the hospital in the previous year for revascularization, wound-related care, or both. Including the year before amputation, the mean cost of inpatient care (including the amputation procedure itself) was $22,405, but ranged significantly from $11,077 (Bismarck, ND) to $42,613 (Salinas, CA) (P<0.001). Vascular procedures were significantly more likely to be performed in patients in high-spending regions, both in crude analyses (P<0.001) and in risk-adjusted analyses (P<0.001). While revascularization was associated with higher spending (P<0.001), higher spending was not associated with lower regional amputation rates (P=0.06).
“There is little evidence that higher regional spending is associated with lower amputation rates,” the authors write.