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Currently, 1.9 million people are living with limb loss in the United States, with an average of 507 people continuing to lose a limb every day. This results in an estimated 185,000 amputations per year (1), and this number is expected to double by the year 2050 due to increasing rates of diabetes and vascular disease (1). Among those living with limb loss, the major causes of their amputations are vascular disease (54%) – including diabetes and peripheral arterial disease – trauma (45%) and cancer (less than 2%) (2). The most common causes of pediatric amputations, however, are lawn mower accidents (3). Non-whites comprise about 42% of the limb loss population in the U.S. (1). In 2008, the diabetes related amputation rate among African Americans was nearly four times that of whites (4).
A total of 3,108 amputations were performed in Arizona hospitals in 2013. These amputations were performed for a variety of reasons, including diabetes and peripheral arterial disease complications. The following information details the trends and most current rates of amputation and diabetes in Arizona.
1. AMPUTATION TRENDS OVER TIME
According to hospital discharge data, the number of total amputations performed in Arizona each year increased by 76.99% from 1997-2013. A total of 39,933 of these procedures occurred in this time period. The numbers were at their lowest (1,756) in 1997, and the number of amputations was highest (3,108) in 2013. (See Graph 1.1)
The number of upper-extremity amputations performed each year from 1997 to 2013 totaled 4,686. The lowest incidence of these amputations (154) occurred in 1997, while 2000 saw the most upper-extremity amputations (492). A 101.9% increase in upper-extremity amputations can be observed from 1997 to 2013. (See Graph 1.2)
The number of lower-extremity amputations performed each year ultimately increased by 74.95% from 1997 to 2013. A total of 35,257 of these procedures occurred in this time period. The highest incidence (2,797) occurred in 2013, and the lowest incidence (1,602) occurred in 1997. (See Graph 1.3)
2. Types of Amputations Performed
283 upper-extremity amputations were performed in 2013. The most common minor upper-extremity amputation was of the fingers (250) and no major upper limb amputations were reported (See Graph 2.1)
2,779 lower-extremity amputations were performed in 2013. In terms of minor lower-extremity amputations, toes (1,369) were amputated more often than part of the foot (369). For major lower-extremity amputations, below-knee (670) amputation was the most common procedure, followed by above knee amputation (326). (See Graph 2.2)
3. WHO LOSES A LIMB?
In 2013, most amputations were performed on individuals aged 45-64 years old, followed by the age group of 65-84 year olds (See Graph 3.1).
There were more than 2 times more amputations performed on male patients in Arizona than on female patients (See Graph 3.2).
Medicare recipients ranked as the most common group to have an amputation procedure (See Graph 3.3).
We can see that the African American population of Michigan bears the heaviest burden of amputation (0.055% of the African American population underwent amputations). This is evident when compared with the percentage of the white population that underwent amputations (0.039%), with the Hispanic population that underwent amputations (.039%), and with amputations in the state’s population as a whole (0.048). (See Graph 3.4)
* According to Census Bureau estimation data (http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=CF) the population of Arizona in 2010 was about 6,392,017 and was made up of about 4,667,121 white residents, 259,008 African American residents, and 1,895,159 Hispanic residents.
4. DIABETES TRENDS
Diabetes is a leading cause of lower-extremity amputations 5. The prevalence of diabetes in the adult population of Arizona increased 426.7% from 1994 to 2013. (See Graph 4.1)
The annual rate of existing cases of diabetes among adults in Hawaii decreased 70.45% from 1994 to 2013. Data from 2004 is unavailable. (See Graph 4.2)
5. HEALTHCARE COSTS
For persons with a unilateral lower-extremity amputation, the two year healthcare costs, including initial hospitalization, inpatient rehabilitation, outpatient physical therapy, and purchase and maintenance of a prosthetic device, is estimated to be $91,106. The lifetime healthcare cost for persons with a unilateral lower extremity amputation is estimated to be more than $500,000 6. It is anticipated that these healthcare costs would be higher for a person with a proximal amputation level and bilateral amputation status, due to higher prosthetic costs.
Charges represent what the hospital billed for the case, and may not represent all discharges for amputations. (See graph 5.1)
Charges represent what the hospital billed for the case, and may not represent all discharges for amputations. (See graph 5.2)
1. Ziegler-Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R. Estimating the Prevalence of Limb Loss in the United States: 2005 to 2050. Archives of Physical Medicine and Rehabilitation2008;89(3):422-9.
2. Coalition LLTFA. Recommendations from the 2012 Limb Loss Task Force: Roadmap for Preventing Limb Loss in America. [White Paper]. 2012 February 9-12.
3. Bryant PR, Pandian G. Acquired limb deficiencies. 1. Acquired limb deficiencies in children and young adults. Archives of Physical Medicine and Rehabilitation2001;82(3B):00s3-s8.
4. Li Y, Burrows NR, Gregg EW, Albright A, Geiss LS. Declining Rates of Hospitalization for Nontraumatic Lower-Extremity Amputation in the Diabetic Population Aged 40 Years or Older: U.S., 1988-2008. Diabetes Care2012;35(2):273-7.
5. Ventkataraman PKM. Impact of patient counseling on diabetic foot ulcer patients. Indo American Journal of Pharmaceutical Research2012;2(10):1213-9.
6. MacKenzie EJ. Health-Care Costs Associated with Amputation or Reconstruction of a Limb-Threatening Injury. The Journal of Bone and Joint Surgery (American)2007;89(8):1685.
It is not the intention of the Amputee Coalition to provide specific medical or legal advice but rather to provide consumers with information to better understand their health and healthcare issues. The Amputee Coalition does not endorse any specific treatment, technology, company, service or device. Consumers are urged to consult with their healthcare providers for specific medical advice or before making any purchasing decisions involving their care.
National Limb Loss Resource Center, a program of the Amputee Coalition, located at 900 East Hill Ave., Suite 390, Knoxville, TN 37915 | 888/267-5669
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