OBJECTIVE：Using the National Health Insurance research database, we investigated diabetic patients in Taiwan with peripheral artery occlusive disease. To see if revascularization procedures would protect patients from major lower limb amputation. Also, we analyze the utilization of health care in admission. We expect that the results will be useful for the health administration to make a medical policy for these patients and more fully utilization of the National Health Insurance.
METHODS：We used the National Health Insurance research database from the National Health Research Institute. We collected from the ambulatory care claim in the diabetic special topic files, the patients in 2002 who had been diagnosed with both diabetes and peripheral artery occlusive disease (PAOD). We followed up with these patients for 7 years (2002-2008). We collected the numbers of patients who had revascularization procedures, major lower limb amputation and inpatient claims.
RESULTS：The total number of patients with diabetes and PAOD from 2002 ambulatory care claim was 1463. There were 213 patients with revascularization from the inpatient claims databases(2002-2008). 63(29.58%) of these 213 patients suffered from major lower limb amputation. There were 1250 patients without revascularization and 263(21.04%) of these patients suffered from major lower limb amputation. The revascularized patients had significant higher rates of major lower limb amputation than those without revascularization (p=0.006<0.05). No significant difference was noted of the length of the hospital stay between revascularized and non-revascularized patients(p=0.2258). There was significant difference of inpatient claims between revascularized and non-revascularized patients(p<0.05). The highest report of an inpatient claim occurred in the revascularized patients with major lower limb amputation(NT$441,737). The 2nd highest one occurred in the revascularized patients without major lower limb amputation(NT$216,372). The 3rd highest one occurred in the non-revascularized patients with major lower limb amputation(NT$166,962). In the logistic regression analysis, revascularization and older age were significant predictors of major lower limb amputation (revascularization odds ratio 1.4279).
CONCLUSION: Revascularization does not reduce the major lower limb amputation in these DM patients with PAOD. Because of limited medical resources, we should carefully consider applying the revascularization procedure for future patients.
Keywords：Diabetes, Peripheral artery occlusive disease, Revascularization, Major lower limb amputation