Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Availability of vascular surgeons impacts amputation rate

11.07.2005


Rice University/Baylor College of Medicine study focuses on peripheral arterial disease



Patients with peripheral arterial disease (PAD) are more likely to have a foot or leg amputated if they live in a region that has few vascular surgeons, according to a Rice University/Baylor College of Medicine study published in the July issue of the Journal of Vascular Surgery.

"We found that areas of the country that had higher numbers of vascular surgeons had more bypass surgery performed and lower amputation rates," said principal investigator Vivian Ho, a health economist at Rice’s Baker Institute for Public Policy and an associate professor of medicine at Baylor.


PAD is a condition in which fatty deposits build up on the inner linings of arteries, restricting the flow of blood to muscles and organs, especially the kidneys, stomach, arms, legs and feet. About 8 million to 12 million people are affected by PAD. The disease accounts for about half of all amputations among diabetics and is the major cause of amputation for nondiabetic patients.

Treatment often entails lifestyle changes and medication. Sometimes amputations can be avoided through bypass surgery in the lower extremities that improves blood circulation in the legs and feet; this procedure must be performed by vascular surgeons.

Amputation rates can vary as much as tenfold in different areas of the U.S., so Ho wanted to analyze whether the availability of vascular surgeons in a region affects revascularization and amputation rates for patients with PAD. Collaborating with the University of Alabama in Birmingham and Intermountain Health Care in Salt Lake City, Utah, Ho identified all patients with PAD in the Medicare claims data in 1994 and tracked their claims through 1999. She separated data on more than 143,200 patients who survived through 1999 by hospital referral region and merged it with information on the supply of local physicians and vascular surgeons.

Ho’s statistical analysis of the data revealed that a .30 increase in the number of vascular surgeons per 10,000 Medicare beneficiaries resulted in almost a 1 percent increase in bypass surgery rates and a 1.6 percent reduction in amputation rates.

The study suggests that the likelihood a patient with PAD undergoes revascularization might depend on access to vascular specialists. But Ho found a "substantial disparity" in the supply of vascular surgeons across the country. Although this disparity might be expected, due to differences in the incidence of PAD in various regions of the nation, Ho found that even after allowing for the varying rates of the disease by location, the supply of vascular surgeons was strongly related to the attractiveness of an area. The nation’s 1,500 vascular surgeons treating Medicare patients are more likely to live in locations with high rankings in "Places Rated Almanac," which compares cities in terms of recreation, education, transportation, arts, cost of living, climate, crime rate, health care, jobs and other marketing criteria. "Regional variability in specialists who treat PAD is influenced by factors other than regional medical needs," said Ho, who is also an associate professor of economics at Rice.

She noted, for example, that Houston ranks No. 8 in the "Places Rated Almanac" and has 50 percent more vascular surgeons per capita than Corpus Christi, Texas, which ranks No. 179. In turn, the amputation rate among Medicare beneficiaries in Houston is only half that found in Corpus Christi (2 versus 4.35 per 10,000 Medicare beneficiaries).

Ho also studied the availability of interventional radiologists, who can perform angioplasty in the lower extremities of patients with PAD to improve circulation. "We found weaker evidence that greater availability of interventional radiologists increases angioplasty rates and reduces amputation rates," Ho said.

"What surprised me most about the study is the disparity in the supply of specialists and the fact that so much of the variation in the supply is determined by where the specialists want to live rather than where they are needed most," she said.

To reduce the regional disparities in amputation, policies should be aimed at redistributing the supply of vascular surgeons and interventional radiologists to underserved areas, Ho said. Increasing Medicare reimbursement rates in rural areas that tend to be less attractive for living, offering loan-forgiveness programs to medical school graduates who agree to practice in regions with a low supply of specialists and subsidizing teaching hospitals in low-supply areas are among the policy options that might resolve the disparity.

Ho’s research was supported by a grant from the Agency for Health Care Research and Quality. Her co-authors were Douglas Wirthlin at Intermountain Health Care; Huifeng Yun in the Department of Health Care Organization and Policy at the University of Alabama, Birmingham; and Jeroan Allison in the divisions of General Internal Medicine and Preventive Medicine at the University of Alabama, Birmingham.

B.J. Almond | EurekAlert!
Further information:
http://www.rice.edu

More articles from Health and Medicine:

nachricht Millions through license revenues
27.04.2017 | Rheinische Friedrich-Wilhelms-Universität Bonn

nachricht New High-Performance Center Translational Medical Engineering
26.04.2017 | Fraunhofer ITEM

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Making lightweight construction suitable for series production

More and more automobile companies are focusing on body parts made of carbon fiber reinforced plastics (CFRP). However, manufacturing and repair costs must be further reduced in order to make CFRP more economical in use. Together with the Volkswagen AG and five other partners in the project HolQueSt 3D, the Laser Zentrum Hannover e.V. (LZH) has developed laser processes for the automatic trimming, drilling and repair of three-dimensional components.

Automated manufacturing processes are the basis for ultimately establishing the series production of CFRP components. In the project HolQueSt 3D, the LZH has...

Im Focus: Wonder material? Novel nanotube structure strengthens thin films for flexible electronics

Reflecting the structure of composites found in nature and the ancient world, researchers at the University of Illinois at Urbana-Champaign have synthesized thin carbon nanotube (CNT) textiles that exhibit both high electrical conductivity and a level of toughness that is about fifty times higher than copper films, currently used in electronics.

"The structural robustness of thin metal films has significant importance for the reliable operation of smart skin and flexible electronics including...

Im Focus: Deep inside Galaxy M87

The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.

Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...

Im Focus: A Quantum Low Pass for Photons

Physicists in Garching observe novel quantum effect that limits the number of emitted photons.

The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...

Im Focus: Microprocessors based on a layer of just three atoms

Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.

Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Fighting drug resistant tuberculosis – InfectoGnostics meets MYCO-NET² partners in Peru

28.04.2017 | Event News

Expert meeting “Health Business Connect” will connect international medical technology companies

20.04.2017 | Event News

Wenn der Computer das Gehirn austrickst

18.04.2017 | Event News

 
Latest News

Wireless power can drive tiny electronic devices in the GI tract

28.04.2017 | Medical Engineering

Ice cave in Transylvania yields window into region's past

28.04.2017 | Earth Sciences

Nose2Brain – Better Therapy for Multiple Sclerosis

28.04.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>