The purpose of this study was to assess the association of race with lower extremity non-traumatic amputation versus lower extremity bypass revascularization, after adjusting for relevant clinical variables.

Data were obtained from the Veterans Administration (VA) National Surgical Quality Improvement Program (NSQIP), which took place from 1991 through 1995. All patients who underwent lower extremity amputation or lower extremity bypass revascularization for arterial occlusive disease within the VA NSQIP were eligible.

Among revascularization patients, 3.1% of patients were Hispanic, 17.2% were black, and 79.7% were white. Among amputation patients, 4.8% were Hispanic, 28.9% were black, and 66.2% were white. These racial differences are significant. Other factors associated with use of amputation (rather than revascularization) included poorer functional status (total and partial dependency), having an open wound, impaired sensorium, emergent surgical operations, diabetes, ASA class 4 or 5, dialysis, CHF, rest pain, increasing age, weight loss, and location of the VA center (Northeast). Smoking was associated with lower risk.

In addition to the fourteen preoperative variables tested in the model, analysis by race showed that black patients were 1.5 times more likely than white patients to undergo amputation and Hispanic patients were 1.4 times more likely.

A possible explanation offered for these race differences is that blacks and Hispanics might present with more severe disease. The authors also suggest that provider bias could be responsible. “In the case of PAD, minority patients may be less likely to receive lower extremity revascularization versus amputation as a result of overt, or more likely subconscious, perceptions by the physician of appropriate treatment strategies. Physicians may have subconscious perceptions that PAD patients of certain ethnic groups fare less well with revascularization.”

This study is limited in that no information describing the care process leading to revascularization or amputation is included.