Several factors impacting former service members’ quality of healthcare were identified as contributors to eventual amputation surgeries among the veteran population, authors from Emory Healthcare and the Veterans Health Administration wrote in a JAMA Surgery article published Wednesday.
From 2010 to 2020, lead author Olamide Alabi, a vascular surgeon for both Emory and the VA Healthcare System in Atlanta, and a team of researchers analyzed the year period prior to 19,000 amputation cases to determine how health care contributed to a major loss of limb.
Among the factors discussed, insufficient screening for peripheral artery disease stood out. The affliction, also known as PAD, is considered the leading cause of the approximately 185,000 lower extremity amputations that occur in the U.S. each year.
“[L]imb amputation is ... preventable through early diagnosis, monitoring and medical management and subsequent revascularization,” a statement from Emory read. “The fact that patients can receive such significant variation in quality and speed of diagnostic and therapeutic care before they wind up needing amputation is what drove Alabi to give the issue a closer look at the national level.”
Emory and Veterans Health researchers identified distances to primary care providers and geographic region as factors influencing veterans’ screenings and quality of care. Veterans who lived more than 13 miles from their primary care provider, for example, were less likely to receive vascular screenings, the authors wrote.
Regionally, veterans in the Midwest were more likely to undergo vascular screenings in the year prior to amputation than those in other regions of the country. Such a screening, according to the report, is a critical measure for “quicker intervention” that could possibly stave off an amputation.
“A diagnosis of PAD, which disproportionately impacts veterans, carries with it a myriad of significant concerns,” according to the Emory statement. “With PAD, the risk of heart attack, stroke and death increases threefold. Also, individuals diagnosed with the most severe form of PAD have up to a 25% chance of having to have a limb amputated within one year after diagnosis.”
Approximately 10 million people in the U.S. are diagnosed with PAD each year, the authors wrote. Alabi noted that veteran screenings currently outpace the rate of screenings in the private healthcare sector.
Veterans hospital systems, meanwhile, have reached greater parity across different racial groups of former service members than the private sector.
“There is a great deal of data suggesting that Black patients [in the private healthcare sector] do not get vascular assessments at the same rate as white patients in the private sector,” Alabi said. “At the VHA, however, this study found that Black veterans were either more or just as likely to receive a vascular assessment in the year prior to amputation.”
Alabi suggested an important first step following this study would be to identify best practices in high-performing hospitals or regions to contribute to national guidance on vascular screenings.
Zamone “Z” Perez is a reporter at Military Times. He previously worked at Foreign Policy and Ufahamu Africa. He is a graduate of Northwestern University, where he researched international ethics and atrocity prevention in his thesis. He can be found on Twitter @zamoneperez.
