title: Temporal trends and geographic variation of lower-extremity amputation in patients with peripheral artery disease: results from U.S. Medicare 2000-2008.
abstract: OBJECTIVE
  This study sought to characterize temporal trends, patient-specific factors, and geographic variation associated with amputation in patients with lower-extremity peripheral artery disease (LE PAD) during the study period.
  
  
  BACKGROUND
  Amputation represents the end-stage failure for those with LE PAD, and little is known about the rates and geographic variation in the use of LE amputation.
  
  
  METHODS
  By using data from the Centers for Medicare & Medicaid Services (CMS) from January 1, 2000, to December 31, 2008, we examined national patterns of LE amputation among patients age 65 years or more with PAD. Multivariable logistic regression was used to adjust regional results for other patient demographic and clinical factors.
  
  
  RESULTS
  Among 2,730,742 older patients with identified PAD, the overall rate of LE amputation decreased from 7,258 per 100,000 patients with PAD to 5,790 per 100,000 (p < 0.001 for trend). Male sex, black race, diabetes mellitus, and renal disease were all independent predictors of LE amputation. The adjusted odds ratio of LE amputation per year between 2000 and 2008 was 0.95 (95% CI: 0.95-0.95, p < 0.001).
  
  
  CONCLUSIONS
  From 2000 to 2008, LE amputation rates decreased significantly among patients with PAD. However, there remains significant patient and geographic variation in amputation rates across the United States.
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27710, USA. schuyler.jones@dm.duke.edu
authors.forename: W Schuyler
authors.initials: WS
authors.lastname: Jones
authors.forename: Manesh R
authors.initials: MR
authors.lastname: Patel
authors.forename: David
authors.initials: D
authors.lastname: Dai
authors.forename: Sumeet
authors.initials: S
authors.lastname: Subherwal
authors.forename: Judith
authors.initials: J
authors.lastname: Stafford
authors.forename: Sarah
authors.initials: S
authors.lastname: Calhoun
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply* / Q000601:surgery; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000453:epidemiology / Q000601:surgery*; D011159:Population Surveillance; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology