Relationship between regional spending on vascular care and amputation rate.

Importance: Although lower extremity revascularization is effective in preventing amputation, the relationship between spending on vascular care and regional amputation rates remains unclear.

Objective: To test the hypothesis that higher regional spending on vascular care is associated with lower amputation rates for patients with severe peripheral arterial disease.

Design, Setting, And Participants: Retrospective cohort study of 18,463 US Medicare patients who underwent a major peripheral arterial disease-related amputation during the period between 2003 and 2010.

Regional intensity of vascular care and lower extremity amputation rates.

Objective: Because patient-level differences do not fully explain the variation in lower extremity amputation rates across the United States, we hypothesized that variation in intensity of vascular care may also affect regional rates of amputation and examined the relationship between the intensity of vascular care and the population-based rate of major lower extremity amputation (above-knee or below-knee) from vascular disease.

Methods: Intensity of vascular care was defined as the proportion of Medicare patients who underwent any vascular procedure in the year before amputation, calculated at the regional level (2003 to 2006), using the 306 hospital referral regions in the Dartmouth Atlas of Healthcare. The relationship between intensity of vascular care and major amputation rate, at the regional level, was examined between 2007 and 2009.

Racial disparities in survival among injured drivers.

Prior studies on racial and ethnic disparities in survival after motor vehicle crashes have examined only population-based death rates or have been restricted to hospitalized patients. In the current study, we examined 3 components of crash survival by race/ethnicity: survival overall, survival to reach a hospital, and survival among those hospitalized. Nine years of data (from 2000 through 2008) from the National Automotive Sampling System Crashworthiness Data System were used to examine white non-Hispanic, black non-Hispanic, and Hispanic drivers aged ≥ 15 years with serious injuries (injury severity scores of ≥ 9).

Mortality in rural locations after severe injuries from motor vehicle crashes.

Background: Mortality from traffic crashes is often higher in rural regions, and this may be attributable to decreased survival probability after severe injury.

Methods: Data were obtained from the National Automotive Sampling System - General Estimates System (NASS-GES) for 2002-2008. Using weighted survey logistic regression, three injury outcomes were analyzed: (a) Death overall, (b) Severe injury (incapacitating or fatal), and (c) Death, after severe injury.

Early discharge does not increase readmission or mortality after high-risk vascular surgery.

Purpose: Clinical pathways aimed at reducing hospital length of stay following vascular surgery have been broadly implemented to reduce costs. However, early hospital discharge may adversely affect the risk of readmission or mortality. To address this question, we examined the relationship between early discharge and 30-day outcomes among patients undergoing a high-risk vascular surgery procedure, thoracic aortic aneurysm (TAA) repair.

Peanut allergy diagnoses among children residing in Olmsted County, Minnesota.

Background: Peanut allergy is a major health concern, particularly in developed countries. Research indicates that as many as 2% of children are allergic to peanuts, which represents a 3-fold increase in diagnoses over the past 2 decades.

Objective: This population-based descriptive study used the Rochester Epidemiology Project to estimate the prevalence in 2007 and annual incidence rates of peanut allergy diagnoses from 1999 to 2007 among children residing in Olmsted County, Minnesota.

Variation in the use of lower extremity vascular procedures for critical limb ischemia.

Background: Many believe that variation in vascular practice may affect limb salvage rates in patients with severe peripheral arterial disease. However, the extent of variation in procedural vascular care obtained by patients with critical limb ischemia (CLI) remains unknown.

Methods And Results: By using Medicare 2003 to 2006 data, we identified all patients with CLI who underwent major lower extremity amputation in the 306 hospital referral regions described in the Dartmouth Atlas of Healthcare.

National trends and regional variation of open and endovascular repair of thoracic and thoracoabdominal aneurysms in contemporary practice.

Objectives: Successful surgical management of thoracic aortic aneurysms (TAA) and thoracoabdominal aortic aneurysms (TAAA) has historically relied upon open surgical repair (OSR). More recently, the advent and application of thoracic endovascular stent graft aneurysm repair (TEVAR) permutations have become increasingly performed in contemporary practice. To better determine the effect of TEVAR techniques on OSR, we examined national and regional trends in treatment use.

Explaining regional disparities in traffic mortality by decomposing conditional probabilities.

Background: In the USA, the mortality rate from traffic injury is higher in rural and in southern regions, for reasons that are not well understood.

Methods: For 1754 (56%) of the 3142 US counties, we obtained data allowing for separation of the deaths/population rate into deaths/injury, injuries/crash, crashes/exposure and exposure/population, with exposure measured as vehicle miles travelled. A 'decomposition method' proposed by Li and Baker was extended to study how the contributions of these components were affected by three measures of rural location, as well as southern location.

Risk profiles of progression in primary focal segmental glomerulosclerosis.

Background: Focal segmental glomerulosclerosis (FSGS) is a component of childhood nephrotic syndrome occurring in 10%-20% of all cases. Over time, 25%-50% of children with FSGS develop kidney failure disease. We followed a cohort of children with FSGS in order to delineate the risk profile of progression to kidney failure (KF).

Regional variation in carotid artery stenting and endarterectomy in the Medicare population.

Background: To describe geographic variation in population-based rates of carotid artery stenting (CAS) and carotid endarterectomy (CEA) performed in Medicare beneficiaries.

Methods And Results: Medicare claims and enrollment data were used to calculate age, sex, and race-adjusted rates of CAS and CEA for Medicare beneficiaries in each of 306 hospital referral regions between 1998 and 2007. Procedures were identified using a combination of Current Procedural Terminology codes as well as diagnostic and procedural ICD-9 codes.

Changes in the use of carotid revascularization among the medicare population.

Hypothesis: It remains unknown if the increasing use of carotid artery stenting (CAS) has caused a change in the population-based use of carotid endarterectomy (CEA). We sought to examine national trends in carotid revascularization.

Design: Retrospective cohort study.