The influence of race on the use of surgical procedures for treatment of XXXX of the lower extremities.

@entity1095 @entity1 @entity6 @entity7964
OBJECTIVE: To assess whether rates of amputation and leg-sparing surgery for @entity1095 of the lower extremities differ between African-American and white @entity1 . DESIGN: Retrospective cohort study using Medicare claims data for 1989 and 1990. SETTING: A total of 3313 hospitals in the United States. @entity1 : Random sample of 19,236 Medicare Part A enrollees who underwent amputation and/or leg-sparing surgery for @entity1095 . MAIN OUTCOME MEASURES: Adjusted odds of toe and/or foot amputation, below-knee amputation, above-knee amputation, lower extremity arterial vascularization, and percutaneous transluminal angioplasty for African American relative to whites, controlling for case-mix, region, and hospital characteristics. RESULTS: African-American @entity1 were significantly more likely than white @entity1 to undergo above-knee, below-knee, and toe and/or foot amputation and significantly less likely to undergo lower-extremity arterial revascularization and percutaneous transluminal angioplasty. These associations occurred for @entity6 @entity1 and @entity7964 @entity1 but were more pronounced among @entity1 who did not have @entity6 . CONCLUSIONS: Potential explanations include unmeasured factors such as severity of disease and the technical expertise available at hospitals or other factors such as lack of compliance with medical treatment and race-specific treatment decisions by providers. Whatever the cause, interventions aimed toward reducing the number of amputations among African Americans are needed. Further work is required to determine where such interventions should be targeted.
