Article

OBJECTIVE: To determine whether there is a sex-related disparity in the
management of lower-extremity ischemia by evaluating the relationship between sex
and level of nontraumatic amputation. DESIGN: This is a retrospective secondary
analysis of community hospital data from the Healthcare Cost and Utilization
Project, Nationwide Inpatient Sample for 2007. Level of amputation was determined
from International Classification of Diseases-9th Revision-Clinical Modifications
procedure and coded as either transfemoral or transtibial. The main predictor was
sex; covariates including age, race, income, insurance status, and presence of
vascular disease were incorporated as control variables in regression analysis.
SETTING: Nonfederal, short-term U.S. community hospitals. PARTICIPANTS: Persons
discharged from hospitals with a nontraumatic transtibial or transfemoral
amputation (N=11,114). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES:
Level of limb loss. RESULTS: A significant association was found between female
sex and transfemoral amputation in both the bivariable (chi(2)=187.0; P<.000) and
multivariable analysis (odds ratio [OR]=1.4; 95% confidence interval
[CI]=1.3-1.5). Other covariates significant for influencing level of amputation
during multivariable analysis include age, with highest age greater than 78 years
at highest risk (OR=3.0; 95% CI, 2.6-3.5); 0-25% quartile of income or annual
income less than $36,000 (OR=1.3; 95% CI, 1.1-1.5); Medicare insurance (OR=1.4;
95% CI, 1.1-1.6); Medicaid insurance (OR=1.3; 95% CI, 1.3-1.6); and
cerebrovascular disease (OR=2.0; 95% CI, 1.7-2.4). CONCLUSIONS: Female sex is
significantly associated with transfemoral amputation compared with male sex.
Transfemoral amputation has significant consequences, and further evaluation of
preventative care and screening for women with vascular disease should be
considered.
CI - Copyright A(c) 2011 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS