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Gaps in Vascular Evaluation Before Major Lower-Extremity Amputation Among Medicare Beneficiaries With Chronic Limb-Threatening Ischemia
Shah SK, Neal D, Shah KB, Vasilopoulos T, Segal M, Scali ST, Berceli S, Weissman JS.. medRxiv, 2026-04-28
Topic: Health services, long-term care and technology
Results Among 10,666 patients (mean age 76.6 years; 35% female; 70% White, 21% Black), phenotype distribution was: A, 9.4%; B, 7.1%; C, 50.7%; D, 32.7%. Dementia (OR 2.0; 95% CI, 1.61–2.52), paralysis (OR 4.1; 2.62–6.34), and dual eligibility (OR 1.2; 1.01–1.42) were independently associated with phenotype A. Higher comorbidity burden was inversely associated with A (OR 0.49 for >6 vs 0–3 Elixhauser comorbidities). Results were robust to acuity adjustment, exclusion of early deaths, and propensity-score matching (n=824 pairs). WHAT IS KNOWN Prior studies have shown that 50–63% of Medicare patients with chronic limb-threatening ischemia undergo major amputation without receiving revascularization, with substantial racial and geographic disparities in pre-amputation vascular care. Substantial hospital-level and geographic variation (3–16% phenotype A prevalence across large hospital referral regions) indicates that system-level factors, not just patient characteristics, drive these gaps.
Key findings
- Results Among 10,666 patients (mean age 76.6 years; 35% female; 70% White, 21% Black), phenotype distribution was: A, 9.4%; B, 7.1%; C, 50.7%; D, 32.7%.
- Dementia (OR 2.0; 95% CI, 1.61–2.52), paralysis (OR 4.1; 2.62–6.34), and dual eligibility (OR 1.2; 1.01–1.42) were independently associated with phenotype A.
- Higher comorbidity burden was inversely associated with A (OR 0.49 for >6 vs 0–3 Elixhauser comorbidities).
- Results were robust to acuity adjustment, exclusion of early deaths, and propensity-score matching (n=824 pairs).
- WHAT IS KNOWN Prior studies have shown that 50–63% of Medicare patients with chronic limb-threatening ischemia undergo major amputation without receiving revascularization, with substantial racial and geographic disparities in pre-amputation vascular care.
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Study details
- Study designcohort study
- Participants824
- Effect size9.4%; 7.1%; 50.7%
- Evidence strengthModerate
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 47 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for randomised / blinded because the record does not state it. We have no data on times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 29 of the 62 points we could judge it on, which is 47 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (medRxiv) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 4 / 10 | Preprint — not yet peer-reviewed. Hosted on a preprint server. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 2 / 4 | 824 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 29 / 62 | Scored on 12 of 20 parts. We have no data for the rest, so they are left out: 29 of the 62 points we could judge it on is 47 out of 100. |
| Total | 47 / 100 | Capped to 16 because this is not a peer-reviewed article. |
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 8 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
APA 7th
Shah, S. K., Neal, D., Shah, K. B., Vasilopoulos, T., Segal, M., Scali, S. T., et al. (2026). Gaps in Vascular Evaluation Before Major Lower-Extremity Amputation Among Medicare Beneficiaries With Chronic Limb-Threatening Ischemia. medRxiv. https://doi.org/10.64898/2026.04.27.26351897
Vancouver
Shah SK, Neal D, Shah KB, Vasilopoulos T, Segal M, Scali ST, et al. Gaps in Vascular Evaluation Before Major Lower-Extremity Amputation Among Medicare Beneficiaries With Chronic Limb-Threatening Ischemia. medRxiv. 2026. doi:10.64898/2026.04.27.26351897.
BibTeX
@article{shah2026-3286bd77,
author = {Shah, S. K. and Neal, D. and Shah, K. B. and Vasilopoulos, T. and Segal, M. and Scali, S. T. and Berceli, S. and Weissman, J. S.},
title = {{Gaps in Vascular Evaluation Before Major Lower-Extremity Amputation Among Medicare Beneficiaries With Chronic Limb-Threatening Ischemia}},
journal = {medRxiv},
year = {2026},
doi = {10.64898/2026.04.27.26351897},
url = {https://doi.org/10.64898/2026.04.27.26351897}
}