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Spending on Vascular Care Has Little Effect on Amputations

Cheryl Clark, for HealthLeaders Media, November 21, 2013

Researchers find large regional variations in spending, but little evidence to suggest that aggressive, high-cost treatments for leg revascularization translate into lower rates of amputation.

A Dartmouth Atlas study has found similar trends in leg revascularizations as highlighted in a 2009 study of high healthcare costs in Miami and McAllen, TX. The current findings show that regions where doctors performed more expensive procedures incurring higher Medicare spending generally did not prevent more limb amputations than did doctors in regions where less was spent.

In the 2009 study, "we studied costs of care in the last year of life for people who died," explained Philip Goodney, MD, a vascular surgeon at Dartmouth-Hitchcock Medical Center in Lebanon, NH. "With this new study, we looked at spending in the last year for the leg in people who had amputations," that is, people with lower limb vascular disease that was so serious, amputation would be required within the year.

Limb amputations can be a consequence of poor circulation resulting from untreated diabetes or cardiovascular disease. The belief is that better care can save the leg or at least keep it from requiring surgical removal.

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