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OBJECTIVES: The objective of this study was to investigate if insurance status impacts the prognosis of acute leg ischemia (ALI).
METHODS: A retrospective chart review was performed at a single university tertiary care center using ICD-9 codes for diagnosis and procedure from January 2000 to January 2011. A total of 96 patients were diagnosed with acute lower extremity ischemia, including 66 males and 30 females with a mean age 56 years (range, 19-80). 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 & Medicaid and to patients without insurance coverage. Statistical analysis was performed using proportion z test to evaluate differences among the groups investigated. A p value of ≤ 0.05 is significant.
RESULTS: In this study, ALI occurred more common in African Americans (p=0.0029) and in the patients without insurance coverage (p = 0.0034). Chronic obstructive pulmonary disease (COPD), hypertension (HTN), and acute renal failure (ARF) were significantly higher in the uninsured patients compared to the insured (p = 0.0005, 0.0055, and 0.0034, respectively). The time to hospital admission was significantly longer in uninsured patients than in the insured group (p = 0.0449). The rates of major amputation above ankle were 46% in the patients with commercial insurance, 62% in the government insurance (Medicare & 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 was significantly higher than the rates of minor amputation in both Medicare & Medicaid and uninsured patients (p = 0.005, and < 0.0001, respectively).
CONCLUSIONS: With respect to acute lower extremity ischemia, African Americans present more frequently and are more likely to be uninsured. The incidences of COPD, HTN, and ARF are significantly higher in uninsured patients. The majority of the amputations in Medicare & Medicaid and uninsured populations are likely above ankle. This study suggests government insurance coverage does not prevent major amputation in patients with ALI.