title: Open bypass and endovascular procedures among diabetic foot ulcer cases in the United States from 2001 to 2010.
abstract: OBJECTIVE
  The objective of this study was to evaluate trends in outcomes of inpatient mortality, surgical complications, charges, and length of stay stratified according to open vs endovascular revascularization and amputation status in patients admitted to the hospital with diabetic foot ulcers (DFUs).
  
  
  METHODS
  Inpatient discharge records from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project were used in this retrospective cohort study spanning 2001 to 2010. Multivariate regression analyses were used to simultaneously control for patient demographic and socioeconomic attributes, hospital characteristics, and comorbid case-mix disease severity.
  
  
  RESULTS
  During the study period, 2.5 million inpatient DFU cases were observed, of which 412,051 (16.5%) involved amputation (34.8% major, 61.2% minor). Overall, 211,534 (8.5%) of DFU cases underwent revascularization (43.5% open, 51.1% endovascular treatment [EVT], 5.4% both). From 2001 vs 2010, the volume of open procedures decreased 34.9%, and EVT volume increased 197.1%. The percentage of amputations for DFUs remained relatively unchanged, and a major:minor ratio of 0.534 was observed among all cases. Across specific procedure type and amputation status, multivariate analyses indicated equal or decreased inpatient mortality and lengths of stay since 2001, and inflation-adjusted charges generally increased. The presence of a surgical complication, however, was observed to increase by >50% for open procedures involving minor amputations and >30% for open procedures involving no amputations. Because of many potential factors, surgical complications were noted to exceed approximately 900% among cases of EVT involving major amputations beginning in 2007 relative to 2001.
  
  
  CONCLUSIONS
  This nationally-representative investigation found that DFU admissions are common, long, and costly (often >$100,000 per case), with a marked shift having occurred from open bypass to EVT. Although hospital mortality and length of stay either remained the same or have decreased significantly, an increase in procedure-specific surgical complications was observed across several intervention categories.
authors.affiliation: Southern Arizona Limb Salvage Alliance (SALSA), Division of Vascular and Endovascular Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Ariz; The University of Oklahoma Health Sciences Center, College of Pharmacy, Oklahoma City, Okla. Electronic address: grant-skrepnek@ouhsc.edu.
authors.forename: Grant H
authors.initials: GH
authors.lastname: Skrepnek
authors.affiliation: Southern Arizona Limb Salvage Alliance (SALSA), Division of Vascular and Endovascular Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Ariz.
authors.forename: David G
authors.initials: DG
authors.lastname: Armstrong
authors.affiliation: Southern Arizona Limb Salvage Alliance (SALSA), Division of Vascular and Endovascular Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Ariz.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Mills
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000639:trends; D015897:Comorbidity; D017719:Diabetic Foot / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000191:economics / Q000401:mortality / Q000639:trends*; D005260:Female; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D023821:Limb Salvage / Q000639:trends; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010343:Patient Admission / Q000639:trends; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000401:mortality / Q000639:trends*