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Jiang D, Kuchta K, Amundson J, Tafur A, Morcos O, Lind B, Qamar A, Lee CJ. Increasing prevalence of diabetic peripheral angiopathy and complications in hospitalized patients in the United States. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
We aim to assess prevalence of diabetes related peripheral arterial disease and associated outcomes in hospitalized patients in the United States.
Methods
Trends in hospitalizations in diabetic patients with PAD were determined using the 2003–2017 National Inpatient Sample database. Hospital outcomes including diabetic ulcer incidence, amputations, and revascularizations were analyzed.
Results
The analysis included 10,303,673 hospitalizations in diabetic patients with PAD (DMPAD) during the study period. Prevalence of PAD among patients with diabetes increased over time (p<0.001). The prevalence of foot ulcers in diabetics have also increased over time (p<0.001). The incidence of amputations in patients with diabetes showed a decreasing trend with increasing prevalence of revascularizations from 2003 to 2009. Since 2010 however, rising rates of amputations, both minor and major are seen, especially in younger populations (age 18–49). Hospital costs for amputations have increased ($6.6 billion in 2003 vs $ 14.8 billion in 2017) as well as the costs for revascularization (6.1 billion in 2003 vs $13 billion in 2017) during the study period (p<0.001).
Conclusions
In this analysis of patients with DMPAD, an alarming rate of disease prevalence and in-hospital limb outcomes, including costs, are realized in the current era.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Jiang
- The University of Chicago, Surgery, Chicago, United States of America
| | - K Kuchta
- NorthShore University Health System, Surgery, Chicago, United States of America
| | - J Amundson
- The University of Chicago, Surgery, Chicago, United States of America
| | - A Tafur
- NorthShore University Health System, Cardiology, Chicago, United States of America
| | - O Morcos
- NorthShore University Health System, Surgery, Chicago, United States of America
| | - B Lind
- NorthShore University Health System, Surgery, Chicago, United States of America
| | - A Qamar
- NorthShore University Health System, Cardiology, Chicago, United States of America
| | - C J Lee
- NorthShore University Health System, Surgery, Chicago, United States of America
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Majmudar K, Quintero LD, Fuentes H, Stocker S, Tafur A, Talamonti M. Post-operative venous thromboembolism increased mortality in patients with either adenocarcinoma or non-adenocarcinoma pancreatic cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy150.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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3
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Fuentes HE, Paz LH, Al-Ogaili A, Andrade XA, Oramas DM, Salazar-Adum JP, Diaz-Quintero L, Acob C, Tafur A, Caprini J. Validation of a Patient-Completed Caprini Risk Score for Venous Thromboembolism Risk Assessment. TH Open 2017; 1:e106-e112. [PMID: 31249916 PMCID: PMC6524847 DOI: 10.1055/s-0037-1607339] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 08/29/2017] [Indexed: 02/08/2023] Open
Abstract
Introduction
Individualized risk assessment for venous thromboembolism (VTE) using the Caprini risk score (CRS), coupled with targeted prophylaxis based on the score, is effective in reducing postoperative VTE. Critics contend that using this tool is time consuming for health care providers. We decided to create a patient-completed CRS and conducted a prospective study to compare the scores calculated by a patient with those calculated by a blinded physician for the same patient.
Methods
In phase 1, we interviewed patients in our deep vein thrombosis (DVT) support group who had a history of thrombosis and included their family members to determine areas of misunderstanding in the original CRS. We created a patient-completed form based on these interviews. In phase 2, we further optimized the questions after a CRS-trained, blinded physician scored 20 hospitalized patients during the pilot study. In the final (third) phase, we measured the agreement level between the new form filled out by the trained physicians and those filled out by the patients. The study was approved by our local institutional review board. Using PASS version 11, we determined that a sample size of 37 individuals achieves a power of 80%, to detect a 0.1 difference between the null hypothesis correlation of 0.5 and the alternative hypothesis correlation of 0.7 using a two-sided hypothesis test with a significance level of 0.05. We tabulated the individuals' answers and categorized the scores by using SPSS version 23 to estimate the kappa value, linear correlation, and the Bland–Altman test. A kappa value greater than 0.8 indicated an “almost perfect agreement.”
Results
We tested the first patient-completed CRS version (phase 2) in a 20-patient pilot study. A poor agreement was observed with the body mass index (BMI) responses in multiple iterations, and so we excluded the BMI calculation from the final patient-completed CRS form. We recruited 42 patients with an average age of 55, mostly female (45%), who completed less than college education (62%) to fill out the updated CRS form (phase 3). An almost perfect agreement was found for both the individual questions and the overall score comparing physician and patient answers, resulting in a high correlation (
r
= 0.95). In Bland–Altman, we did not find any trend for extreme values.
Conclusion
We created and validated a patient-completed CRS form that has an excellent agreement level with the physician-completed form. From the results, the physician only needs to calculate the BMI. The average time for a patient to complete the form was 5 minutes. The average time for the physician to finalize the score was approximately 6 minutes. Implementation studies are needed to assess the correlation of the aggregated score, derived from this form, with the occurrence of perioperative VTE.
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Affiliation(s)
- H E Fuentes
- Department of Medicine, Division of Internal Medicine, John Stroger Jr. Hospital, Chicago, Illinois, United States
| | - L H Paz
- Department of Medicine, Division of Internal Medicine, John Stroger Jr. Hospital, Chicago, Illinois, United States
| | - A Al-Ogaili
- Department of Medicine, Division of Internal Medicine, John Stroger Jr. Hospital, Chicago, Illinois, United States
| | - X A Andrade
- Department of Medicine, Division of Internal Medicine, John Stroger Jr. Hospital, Chicago, Illinois, United States
| | - D M Oramas
- Department of Pathology, University of Illinois at Chicago, Chicago, Illinois, United States
| | - J P Salazar-Adum
- Department of Medicine, Division of Internal Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States
| | - L Diaz-Quintero
- Department of Medicine, Division of Internal Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States
| | - C Acob
- Department of Medicine, Division of Internal Medicine, John Stroger Jr. Hospital, Chicago, Illinois, United States
| | - A Tafur
- Department of Medicine, Division of Cardiology and Vascular Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States
| | - J Caprini
- NorthShore University HealthSystem-Emeritus, Pritzker School of Medicine, Evanston, Illinois, United States
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Casanegra A, Mansfield A, Tafur A. Primary venous thromboembolism prophylaxis in patients with solid tumors. J Thromb Thrombolysis 2014; 39:258-9. [PMID: 25486907 DOI: 10.1007/s11239-014-1152-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- A Casanegra
- Cardiovascular Medicine Section, Health Sciences Center, University of Oklahoma, 920 Stanton L Young Blvd., WP3010, Oklahoma, OK, 73104, USA
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Cherrez Ojeda I, Cruz E, León R, Mantilla R, Guerrero T, Soria J, Tafur A, Chica L, Gabino G. Chronic autoimmune urticaria in children. Allergol Immunopathol (Madr) 2009; 37:43-7. [DOI: 10.1016/s0301-0546(09)70251-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cherrez-Ojeda I, Cazar T, Guerrero T, Mantilla R, Uraga E, Tafur A. Urticarial vasculitis and Thyroid autoimmunity: A study of 21 patients. J Allergy Clin Immunol 2006. [DOI: 10.1016/j.jaci.2005.12.505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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