TITLE:
Impact of Insurance Status on the Prognosis of Acute Lower Limb Ischemia
AUTHORS:
Shyamal Premaratne, J. David Neel, Cynthia X. Zhao, Linda D. Doucet, Tze-Woei Tan, Wayne W. Zhang
KEYWORDS:
Ischemia, Lower Extremity, Amputation, Insurance
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.6 No.7,
July
12,
2016
ABSTRACT: The objective of this study was to investigate if the insurance status of patients impacted the treatment options and prognosis in acute limb ischemia (ALI). A retrospective chart review was performed at a single university tertiary care center using ICD-9 codes for the diagnosis and procedure for ALI from January 2000 to January 2011. A total of 96 patients were diagnosed with ALI, comprising of 66 males and 30 females with a mean age of 56 years (range was 19 - 80 years). Time to presentation and prognosis (rate and level of amputation) were analyzed using insurance status as the independent variable. Patients covered under commercial insurance were compared to patients with Medicare and Medicaid and to patients without any insurance coverage. Statistical analysis was performed using the proportion z test to evaluate differences among the groups investigated. A “p” value of ≤0.05 was considered significant. In this study, ALI occurred more commonly in African Americans (p = 0.0029) and in patients without insurance coverage regardless of race (p = 0.0034). Chronic obstructive pulmonary disease (COPD), hypertension (HTN), and acute renal failure (ARF) were significantly higher in the uninsured group, compared to the insured group (p = 0.0005, 0.0055, and 0.0034, respectively). The time to hospital admission was significantly longer in uninsured patients compared to the insured group (p = 0.0449). The rates of major amputation above the ankle were 46% in patients with commercial insurance, 62% in the government insurance (Medicare and Medicaid) group, and 51% in the uninsured group. There was no significant difference in major versus minor amputation in patients with commercial insurances. However, the rates of major amputation were significantly higher than the rates of minor amputation in both Medicare and Medicaid and uninsured patients (p = 0.005, and