Amputee Coalition Fact Sheet

Massachusetts

Web Development Fact Sheet

Updated 02/2019 | Download PDF

INTRODUCTION

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 2,939 amputations were performed in Massachusetts 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 Massachusetts.

1. AMPUTATION TRENDS OVER TIME

According to hospital discharge data, there was an overall 18.61% decrease in total amputations performed in Massachusetts from 1997-2014. A total of 55,212 amputations were performed in this time period. Amputations per year were at the highest in 1997 (3,611) and dropped to their low in 2007 (2,629), and then climbed slightly to 2,939 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

The number of upper- extremity amputations performed each year ultimately decreased 26.7% from 1997 to 2014. A total of 3,165 upper-extremity amputations were performed in this time period. The highest incidence of these amputations (221) occurred in 1997, while 2010 saw the least upper-extremity amputations (135) in this time period. (See Graph 1.2)

The number of lower- extremity amputations performed each year ultimately decreased 17.08% from 1997 to 2014. A total of 51,294 lower-extremity amputations were performed in this time period. A decline in these amputations occurred between the years of 1997 and 2007, with the highest incidence in 1997 (3,349) and the lowest incidence (2,391) occurring in 2007. (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

119 upper-extremity amputation types were recorded in 2014. The most common minor upper-extremity amputations were of the fingers (119) and records indicate that no major upper-extremity procedures were performed. (See Graph 2.1)

1,370 lower-extremity amputations were performed in 2014. In terms of minor lower-extremity amputations, toes (1,370) were amputated more often than part of the foot (420). For major lower-extremity amputations, below-knee (545) 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).

There were nearly 2.5 times more amputations performed on male patients in Massachusetts than on female patients (See Graph 3.2).

SOURCE: HEALTHCARE COST AND UTILIZATION PROJECT HCUPNET DATABASE HCUPNET.AHRQ.GOV

SOURCE: HEALTHCARE COST AND UTILIZATION PROJECT HCUPNET DATABASE HCUPNET.AHRQ.GOV

Medicare recipients (61.14%) ranked as the most common group to have an amputation procedure, followed by private insurance (20.52%) (See Graph 3.3).

We can see that the African American population of Massachusetts bears the heaviest burden of amputation (0.085% of the African American population underwent amputations). This is evident when compared with the percentage of the white population that underwent amputations (0.036%), and with amputations in the state’s population as a whole (0.046%). (See Graph 3.4)

SOURCE: HEALTHCARE COST AND UTILIZATION PROJECT HCUPNET DATABASE HCUPNET.AHRQ.GOV

4. DIABETES TRENDS

SOURCE: CDC BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM GIS.CDC.GOV/GRASP/DIABETES/DIABETESATLAS.HTML

We can see that the African American population of Massachusetts bears the heaviest burden of amputation (0.085% of the African American population underwent amputations). This is evident when compared with the percentage of the white population that underwent amputations (0.036%), and with amputations in the state’s population as a whole (0.046%). (See Graph 3.4)

We can see that the African American population of Massachusetts bears the heaviest burden of amputation (0.085% of the African American population underwent amputations). This is evident when compared with the percentage of the white population that underwent amputations (0.036%), and with amputations in the state’s population as a whole (0.046%). (See Graph 3.4)

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 5.2)

SOURCE: HEALTHCARE COST AND UTILIZATION PROJECT HCUPNET DATABASE HCUPNET.AHRQ.GOV


6. REFERENCES

  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. 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.

© Amputee Coalition. Local reproduction for use by Amputee Coalition constituents is permitted as long as this copyright information is included. Organizations or individuals wishing to reprint this article in other publications, including other websites must contact the Amputee Coalition for permission to do so, by emailing a request to rc@amputee-coalition.org.