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• W4213035923 abstract "Vascular surgery patients from lower socioeconomic status (SES) backgrounds present more ominously with aneurysm rupture and critical limb threatening ischemia (CLTI).1Ultee K.H. Bastos Goncalves F. Hoeks S.E. Rouwet E.V. Boersma E. Stolkeret R.J. et al.Low socioeconomic status is an independent risk factor for survival after abdominal aortic aneurysm repair and open surgery for peripheral artery disease.Eur J Vasc Endovasc Surg. 2015; 50: 615-622Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar Discrepancies such as Durham et al’s2Durham C.A. Mohr M.C. Parker F.M. Bogey W.M. Powell C.S. Stoner M.C. The impact of socioeconomic factors on outcome and hospital costs associated with femoropopliteal revascularization.J Vasc Surg. 2010; 52: 600-607Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar finding of low SES being associated with 10-fold higher risk of postoperative amputation, whereas Ferguson et al3Ferguson H.J.M. Nightingale P. Pathak R. Jayatunga A.P. The influence of socio-economic deprivation on rates of major lower limb amputation secondary to peripheral arterial disease.Eur J Vasc Endovasc Surg. 2010; 40: 76-80Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar conversely reporting a 3% decrease in risk, necessitate a systematic review and meta-analysis to examine SES disparities on presentation severity and outcomes for patients with peripheral artery disease. In December 2020, we searched MEDLINE, Embase, and Cochrane CENTRAL for observational studies and randomized controlled trials evaluating the impact of SES on presentation severity or outcomes for patients undergoing lower extremity bypass or angioplasty. Newcastle-Ottawa Score for risk of bias was defined as low (≥8), moderate (6-7), and high (≤5). Lower SES was defined by reported lower income bracket (≤40,000 USD/y/household), higher national deprivation index quartile (low SES: NDI 4 vs high SES: NDI 1), and rural/isolated town and insurance status (low SES: Medicaid, Medicare, no insurance vs high SES: private insurance).1Ultee K.H. Bastos Goncalves F. Hoeks S.E. Rouwet E.V. Boersma E. Stolkeret R.J. et al.Low socioeconomic status is an independent risk factor for survival after abdominal aortic aneurysm repair and open surgery for peripheral artery disease.Eur J Vasc Endovasc Surg. 2015; 50: 615-622Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar,4Henry A.J. Hevelone N.D. Belkin M. Nguyen L.L. Socioeconomic and hospital-related predictors of amputation for critical limb ischemia.J Vasc Surg. 2011; 53: 330-339.e331Abstract Full Text Full Text PDF PubMed Scopus (89) Google Scholar Presentation severity was defined as CLTI presentation. Postoperative amputation rate was captured from study inauguration to 5-year postintervention. Eleven observational studies were included comparing 485,473 low SES patients with 984,908 high SES patients (Table). One prospective study had a moderate risk of bias. Of the remaining10 retrospective studies, 5 had low, 4 had moderate, and 1 had high risk of bias.TableIncluded studies characteristics and quality of studies scoringSourceCountryStudy designName of trial, database, and recruitment periodNo. of patientsSurgical interventionOutcomes of interestSelectionComparabilityOutcomeSumArya 20185Arya S. Binney Z. Khakharia A. Brewster L.P. Goodney P. Patzer R. et al.Race and socioeconomic status independently affect risk of major amputation in peripheral artery disease.J Am Heart Assoc. 2018; 7: e007425Crossref PubMed Scopus (67) Google ScholarUnited StatesRetrospectiveNational veterans' health administration corporate data152,010AmputationAmputation3238Durham 20102Durham C.A. Mohr M.C. Parker F.M. Bogey W.M. Powell C.S. Stoner M.C. The impact of socioeconomic factors on outcome and hospital costs associated with femoropopliteal revascularization.J Vasc Surg. 2010; 52: 600-607Abstract Full Text Full Text PDF PubMed Scopus (27) Google ScholarUnited StatesRetrospectiveSingle Institution187Femoropopliteal revascularization (open and endovascular)Primary-assisted patency related to the initial treatment modality3036Ferguson 20103Ferguson H.J.M. Nightingale P. Pathak R. Jayatunga A.P. The influence of socio-economic deprivation on rates of major lower limb amputation secondary to peripheral arterial disease.Eur J Vasc Endovasc Surg. 2010; 40: 76-80Abstract Full Text Full Text PDF PubMed Scopus (42) Google ScholarUnited KingdomRetrospectiveOPCS4163Lower limb amputationLower limb amputation rate3036Hawkins 20196Hawkins R.B. Mehaffey J.H. Charles E.J. Kern J.A. Schneider E.B. Tracci M.C. Socioeconomically Distressed Communities Index independently predicts major adverse limb events after infrainguinal bypass in a national cohort.J Vasc Surg. 2019; 70: 1985-1993.e1988Abstract Full Text Full Text PDF PubMed Scopus (10) Google ScholarUnited StatesRetrospectiveVQI (Virginia Quality Initiative)40,109Infrainguinal bypassMajor adverse limb events4037Henry 20114Henry A.J. Hevelone N.D. Belkin M. Nguyen L.L. Socioeconomic and hospital-related predictors of amputation for critical limb ischemia.J Vasc Surg. 2011; 53: 330-339.e331Abstract Full Text Full Text PDF PubMed Scopus (89) Google ScholarUnited StatesRetrospectiveNIS (Nationwide Inpatient Sample)475,802Lower extremity revascularization, major amputationMajor lower extremity amputation4138Hughes 20197Hughes K. Mota L. Nunez M. Sehgal N. Ortega G. The effect of income and insurance on the likelihood of major leg amputation.J Vasc Surg. 2019; 70: 580-587Abstract Full Text Full Text PDF PubMed Scopus (14) Google ScholarUnited StatesRetrospectiveNIS (National Inpatient Sample)83,242Major amputation, revascularization (open or endovascular)Incidence of amputations and revascularizations, patient comorbid conditions, postoperative complications3137McGinigle 20148McGinigle K.L. Kalbaugh C.A. Marston W.A. Living in a medically underserved county is an independent risk factor for major limb amputation.J Vasc Surg. 2014; 59: 737-741Abstract Full Text Full Text PDF PubMed Scopus (14) Google ScholarUnited StatesRetrospectiveNorth Carolina Inpatient Discharge Database222,920AmputationNumber of major amputations4239Minc 20209Minc S.D. Hendricks B. Misra R. Ren Y. Thibault D. Marone L. et al.Geographic variation in amputation rates among patients with diabetes and/or peripheral arterial disease in the rural state of West Virginia identifies areas for improved care.J Vasc Surg. 2020; 71: 1708-1717.e1705Abstract Full Text Full Text PDF PubMed Scopus (10) Google ScholarUnited StatesRetrospectiveWest Virginia Health Care Authority Data458,776AmputationAmputation rate4138Rowe 201010Rowe V.L. Weaver F.A. Lane J.S. Etzioni D.A. Racial and ethnic differences in patterns of treatment for acute peripheral arterial disease in the United States, 1998-2006.J Vasc Surg. 2010; 51: 21S-26SAbstract Full Text Full Text PDF PubMed Scopus (49) Google ScholarUnited StatesRetrospectiveNationwide Inpatient Sample29,768Bypass graft, amputation, endovascularUse of amputation, revascularization, or endovascular3025Tunis 199311Tunis S.R. Bass E.B. Klag M.J. Steinberg E.P. Variation in utilization of procedures for treatment of peripheral arterial disease. A look at patient characteristics.Arch Intern Med. 1993; 153: 991-998Crossref PubMed Google ScholarUnited StatesProspectiveSingle Institution7080Amputation or revascularizationAmputation or revascularization3036Ultee 20151Ultee K.H. Bastos Goncalves F. Hoeks S.E. Rouwet E.V. Boersma E. Stolkeret R.J. et al.Low socioeconomic status is an independent risk factor for survival after abdominal aortic aneurysm repair and open surgery for peripheral artery disease.Eur J Vasc Endovasc Surg. 2015; 50: 615-622Abstract Full Text Full Text PDF PubMed Scopus (27) Google ScholarNetherlandsRetrospectiveSingle Institution324Bypass, amputationAmputation, mortality3238Selection: Adequate case definition, representative of nonexposed cohort, ascertainment of exposure; demonstration of outcome was not present at the start of the study.Comparability: Comparability of cohort based on the design or analysis controlled for confounders.Outcome: Assessment of outcome, sufficient, and adequate follow-up.Sum Mean: Sum of selection, comparability, and outcome score.Risk of bias was defined as low (Newcastle-Ottawa Score [NOS] score ≥8), moderate (NOS score 6-7), and high (NOS score ≤5).NOTE: All outcomes reported in these 11 studies were recorded for transparency and completeness. Some outcomes (eg, primary-assisted patency) may not be analyzed because of the insufficient number of studies for meta-analysis. Open table in a new tab Selection: Adequate case definition, representative of nonexposed cohort, ascertainment of exposure; demonstration of outcome was not present at the start of the study. Comparability: Comparability of cohort based on the design or analysis controlled for confounders. Outcome: Assessment of outcome, sufficient, and adequate follow-up. Sum Mean: Sum of selection, comparability, and outcome score. Risk of bias was defined as low (Newcastle-Ottawa Score [NOS] score ≥8), moderate (NOS score 6-7), and high (NOS score ≤5). NOTE: All outcomes reported in these 11 studies were recorded for transparency and completeness. Some outcomes (eg, primary-assisted patency) may not be analyzed because of the insufficient number of studies for meta-analysis. Lower SES was associated with more frequent CLTI presentation (odds ratio: 1.17; 95% confidence interval: 1.08-1.27; P = .0002) and, postoperatively, associated with a 28% higher risk of amputation (relative risk: 1.28; 95% confidence interval: 1.14-1.45; P < .0001). In summary, this meta-analysis of 11 studies of 1,470,381 patients demonstrated that lower SES is associated with more severe disease presentation in the form of CLTI and higher rates of postoperative amputation after revascularization. SES is a strong determinant of health and a predictor of lower access to care. Past studies demonstrate that those of lower SES are more likely to be treated in lower volume institutions.4Henry A.J. Hevelone N.D. Belkin M. Nguyen L.L. Socioeconomic and hospital-related predictors of amputation for critical limb ischemia.J Vasc Surg. 2011; 53: 330-339.e331Abstract Full Text Full Text PDF PubMed Scopus (89) Google Scholar Our findings suggest that greater efforts are needed to improve the care of peripheral artery disease patients with lower SES to address this health inequity." @default.
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• W4213035923 title "Lower socioeconomic status is associated with higher rates of critical limb ischemia presentation and post-revascularization amputation" @default.
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