More spending on PAD revascularizations doesn’t mean fewer amputations

Although revascularizations in patients with peripheral artery disease (PAD) are meant to prevent amputations, a study published online Nov. 20 in JAMA Surgery found that areas in the country where revascularizations in the year before amputation were more frequent did not have lower rates of amputation.

“Medicare spending on patients with severe PAD varies more than 2-fold across the United States, and the regions where spending is the highest perform the most revascularization procedures in the year prior to amputation,” wrote the authors, led by Philip P. Goodney, MD, MS, of Dartmouth-Hitchcock Medical Center in Lebanon, N.H. They undertook the study to determine the relationship between spending on these procedures and amputation rates.

The investigators used Medicare claims data from 2003 through 2010 and identified 18,463 patients with severe PAD who underwent amputation. Sixty-four percent of them had vascular procedures done in the hospital (revascularizations and/or debridements) and the remaining 36 percent did not require hospitalization in the year before amputation. The researchers then determined the total cost, defined as the cost of hospitalization after amputation plus the cost of hospitalization after revascularization and debridement for the group hospitalized prior to amputation and cost of hospitalization after amputation for the group not hospitalized prior to amputation.

The average cost of care for hospitalized patients in the year before amputation was $22,405, which varied throughout the country. In the areas where spending was the highest, vascular procedures were more likely in patients with PAD (12 procedures per 10,000 patients in the lowest-spending areas vs. 20.4 procedures per 10,000 patients in the highest-spending areas).

However, there was no association between higher spending and lower amputation rates. Areas that performed more procedures were the most likely to spend more and have higher amputation rates.

Their study, wrote the authors, “suggests an opportunity to limit costs in vascular care without compromising quality.”