Baker, Frank

Cronenwett, Jack L.

Goldberg, Joshua B.

Goodney, Philip P.

Elsevier - Publisher Connector 

PS186. The Effect of Risk and Race on Amputations among Medicare Diabetics: An Opportunity to Focus National Quality Improvement Initiatives 

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JOURNAL OF VASCULAR SURGERY
June Supplement 201178S Abstractssure is 11% to 49% of the operator, greatest in Left Lateral
oblique projection. The assistant’s radiation exposure is
23% to 46% of the operator’s.
Conclusions: Deliberate variations in technique result
in significant reductions in your radiation exposure.
Author Disclosures: P. K. Agarwal: Nothing to disclose;
N. J. Halin: Nothing to disclose;O. P. Haqqani: Nothing
to disclose; M. D. Iafrati: Nothing to disclose.
PS186.
The Effect of Risk and Race on Amputations among
Medicare Diabetics: An Opportunity to Focus National
Quality Improvement Initiatives
Joshua B. Goldberg1, Philip P. Goodney1, Jack L. Cronen-
wett1, Frank Baker2. 1Dartmouth Hitchcock Medical Cen-
ter, Lebanon, NH; 2New York Medical College, Valhalla,
NY
Objectives: The impact of national quality initiatives
aiming at limiting lower extremity amputations (AMPS) in
diabetics remains uncertain. Therefore, we explored trends
in AMPS among Medicare diabetics with a focus on those
at highest risk.
Methods: The Diabetes Analytic File, an enhanced
sample of all diabetics from the Medicare 5% sample, was
used to study the national incidence of AMPS in diabetics.
Within a cohort of 5 million diabetics between 1999-
2006, we compared the incidence of AMPS in high-risk
(ESRD or  3 comorbidities) and low-risk groups, and by
race.
Results: A total of 23,976 AMPS were performed
between 1999 and 2006; 11,558 in high risk and 12,418 in
low risk patients. The rate of AMPS declined over time (4.8
per 1000 in 1999, 4.4 in 2006, p0.001). Over time,
high-risk patients represented a growing proportion of all
AMPS (33% in 1999, 50% in 2006; p0.001) despite
representing a minority of all diabetics (4% in 1999 to 10%
in 2006, p0.001). The incidence of AMPS was 10 fold
higher in the high-risk group (29.6 per 1000) versusoow-risk patients (2.7 per 1000, p0.001), and African
mericans had higher rates of AMPS, in both high and
ow-risk groups (Figure 1).
Conclusions: Although high-risk patients represent a
inority of Medicare diabetics, they account for 50% of all
MPS, and this effect is magnified in African Americans.
uture QI efforts should focus on high-risk patients and
frican Americans.
uthor Disclosures: F. Baker: Nothing to disclose; J. L.
ronenwett: Nothing to disclose; J. B. Goldberg: Noth-
ng to disclose; P. P. Goodney: Nothing to disclose.
S188.
rediction of Outcome of Treatment of Osteomyelitis
n Diabetic Foot after Minor Amputation: The Role of
R Imaging
onstantijn Hazenberg1, Martin Kraai2, Frans Moll1, Sjef
an Baal2. 1University Medical Center Utrecht, Utrecht,
etherlands; 2Ziekenhuisgroep Twente, Almelo, Nether-
ands
Objectives: The aim of this study was to evaluate the
ole of magnetic resonance imaging (MRI) in the pre-
perative mapping of the extension of osteomyelitis in
he diabetic foot before minor (toe) amputation and to
est the hypothesis that amputation through a osteomy-
litis free level results in an improved wound healing.
Methods: A total of 22 minor amputations in 21
iabetic patients with persistent osteomyelitis despite con-
ervative therapy (antibiotics), were evaluated prospectively
fter minor amputation. Patients with peripheral arterial
isease were excluded. All patients underwent MR imaging
f the foot prior to amputation. During amputation, a bone
iopsy underneath the ulcer was performed and at the level
f amputation (caput metatarsal) for histopathological di-
gnosis. Agreement between MRI and histopathological
iagnosis of osteomyelitis was assessed. Furthermore,
ound healing after amputation was analyzed. Wound
ealing within three months after amputation was regarded
s successful.
Results: Diagnostic performance of MRI for the con-
rmation of osteomyelitis of bone underneath an ulcer and
t the level of amputation showed a 100% sensitivity
17/17 and 7/7 respectively) and 80% specificity (4/5 (1
alse positive case) and 12/15 (3 false positive cases) re-
pectively) for both locations. Positive predictive value was
4% and 70% respectively. There was no difference in
ound healing tendency in case histology and MRI was
ositive or negative for osteomyelitis at the level of
mputation.
Conclusions: MR imaging is reliable in diagnosing the
xtension of osteomyelitis in the diabetic foot. Wound
ealing seems not to be dependant on the presence of
steomyelitis at amputation level.


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PS186. The Effect of Risk and Race on Amputations among Medicare Diabetics: An Opportunity to Focus National Quality Improvement Initiatives

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