Updated 02/2019 | Download PDF
INTRODUCTION
Currently, 1.9 million people are living with limb loss in the United States, and an average of 507 people continue 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 5,815 amputations were performed in Illinois hospitals in 2014. 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 Illinois.
1. AMPUTATION TRENDS OVER TIME
The number of total amputations performed in Illinois each year ultimately increased by 11.46% from 2009-2014 according to hospital discharge data. A total of 32,431 amputation procedures were performed in this time period. After a low of 5,217 in 2009, amputation trends have climbed to 5,815 in 2014.(See Graph 1.1)
SOURCE: HEALTHCARE COST AND UTILIZATION PROJECT HCUPNET DATABASE HCUPNET.AHRQ.GOV
SOURCE: HEALTHCARE COST AND UTILIZATION PROJECT HCUPNET DATABASE HCUPNET.AHRQ.GOV
Between 2009 and 2014, the number of upper- extremity amputations performed each year saw a 16.83% increase. A total of 1,861 upper- extremity amputations were performed in this time period. (See Graph 1.2)
A total of 30,461 lower-extremity amputations were performed in Illinois from 2009 to 2014. The lowest incidence of these procedures occurred at in 2009 (4,886) and climbed to the highest point in 2014 (5,454). There was a 11.63% increase in this time period. (See Graph 1.3)
SOURCE: HEALTHCARE COST AND UTILIZATION PROJECT HCUPNET DATABASE HCUPNET.AHRQ.GOV
2. TYPES OF AMPUTATION PERFORMED
SOURCE: HEALTHCARE COST AND UTILIZATION PROJECT HCUPNET DATABASE HCUPNET.AHRQ.GOV
339 upper-extremity amputations were performed in 2014. The most common minor upper-extremity amputations were of the fingers (282) and the most common major upper-extremity procedures were above the elbow (14). (See Graph 2.1)
5,449 lower-extremity amputations were performed in 2014. In terms of minor lower-extremity amputations, toes (2,703) were amputated more often than part of the foot (744). For major lower-extremity amputations, below-knee (1,121) amputation was the most common procedure. (See Graph 2.2)
SOURCE: HEALTHCARE COST AND UTILIZATION PROJECT HCUPNET DATABASE HCUPNET.AHRQ.GOV
3. WHO LOSES A LIMB?
SOURCE: HEALTHCARE COST AND UTILIZATION PROJECT HCUPNET DATABASE HCUPNET.AHRQ.GOV
In 2014, 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).
Medicare recipients ranked as the most common group to have an amputation procedure (See Graph 3.3).
SOURCE: HEALTHCARE COST AND UTILIZATION PROJECT HCUPNET DATABASE HCUPNET.AHRQ.GOV
SOURCE: HEALTHCARE COST AND UTILIZATION PROJECT HCUPNET DATABASE HCUPNET.AHRQ.GOV
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 Illinois bears the heaviest burden of amputation (0.086% of the African American population underwent amputations). This is evident when compared with the percentage of the white population that underwent amputations (0.034%), and with amputations in the state’s population as a whole (0.045%). (See Graph 3.4)
*According to Census Bureau estimation data (http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?s rc=CF) the population of Illinois in 2014 was about 12,868,747 and was made up of about 9,331,376 white residents and 1,849,054 African American residents.
SOURCE: CDC BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM GIS.CDC.GOV/GRASP/DIABETES/DIABETESATLAS.HTML
4. AMPUTATION COSTS
SOURCE: CDC BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM GIS.CDC.GOV/GRASP/DIABETES/DIABETESATLAS.HTML
In 2014, a total of 1,001,070 Illinois residents indicated that they had been diagnosed with diabetes at some point in their lives. The revalence of diabetes in the population of Illinois increased 124.4%from 1994 to 2014. (See Graph 4.1)
The annual rate of existing cases of diabetes among adults in Illinois increased 74.07% from 1994 to 2014. (See Graph 4.2)
SOURCE: CDC BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM GIS.CDC.GOV/GRASP/DIABETES/DIABETESATLAS.HTML
5. HEALTHCARE COSTS
SOURCE: HEALTHCARE COST AND UTILIZATION PROJECT HCUPNET DATABASE HCUPNET.AHRQ.GOV
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 (5). 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)
SOURCE: HEALTHCARE COST AND UTILIZATION PROJECT HCUPNET DATABASE HCUPNET.AHRQ.GOV
6. REFERENCES
- 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.
- Coalition LLTFA. Recommendations from the 2012 Limb Loss Task Force: Roadmap for Preventing Limb Loss in America. [White Paper]. 2012 February 9-12.
- 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.
- 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.
- 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.
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