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Currently, about 1.9 million people are living with limb loss in the United States. People lose their limbs for many reasons. Of the 1.9 million, 54 percent lost their limb(s) due to complications related to vascular disease (including diabetes and peripheral arterial disease), 45 percent lost their limb(s) due to a traumatic accident, and less than 2 percent had an amputation due to cancer. Non-whites make up about 42 percent of the limb loss population in the United States. The number of people living with limb loss in the country is expected to double by 2050 due to growing rates of diabetes and vascular disease (1).
Each year, an estimated 185,000 amputations are performed in the United States (2). The leading causes of amputation in adults are vascular disease (including complications related to diabetes and peripheral arterial disease), trauma and cancer. According to the Centers for Disease Control and Prevention, in 2009 there were 68,000 amputations due to complications from diabetes (3).
A total of 2,732 amputations were performed in Massachusetts hospitals in 2012. This fact sheet discusses the trends and most current incidence of amputation in Massachusetts.
1. AMPUTATION TRENDS (1997 – 2012)
According to national hospital discharge data, the number of amputations performed in Massachusetts decreased by 24.3 percent from 1997 to 2012 (see Graph 1.1). During this time period, the number of amputations performed in the United States actually increased by 3.6 percent.
A total of 49,365 amputations were performed in Massachusetts from 1997 to 2012. This represents 2.1 percent of the 2,294,679 amputations performed in the U.S. during this time period.
From 1997 to 2012, a total of 2,829 upper-limb amputation procedures were performed in the state of Massachusetts (see Graph 1.2). This represents 5.7 percent of all amputations performed in the state during this time period.
From 1997 to 2012, 162,382 upper-limb amputations were performed in the United States. The number of upper-limb amputations performed in the state of Massachusetts represents 1.7 percent of this national total.
The incidence of upper-limb amputations in Massachusetts ultimately decreased by 33 percent over this time period. The leading causes of upper-limb loss are trauma, cancer, and congenital anomaly (1, 4, 5).
From 1997 to 2012, the number of lower-limb amputations in Massachusetts decreased 24.2 percent (see Graph 1.3). A total of 45,756 lower-limb amputation procedures were performed in the state of Massachusetts in these years. This represents 92.7 percent of all amputation procedures performed in the state.
From 1997 to 2012, 2,132,297 lower-limb amputations procedures were performed in the United States. The number of lower-limb amputation procedures performed in Massachusetts represents 2.1 percent of this national total.The leading causes of lower-limb amputation are complications resulting from dysvascular diseases such as diabetes, and the number of people who lose a limb due to diabetes is expected to almost triple by the year 2050 (1, 4).
2. INCIDENCE OF AMPUTATION (2012)
A total of 2,732 amputation procedures were performed in the state of Massachusetts in 2012, including 148 upper-limb amputations (5.4 percent) and 2,540 lower-limb amputations (93 percent).
Most upper-limb amputations involved the fingers (88.5 percent), followed by thumbs (11.5 percent).
There were no other upper-limb amputation procedures recorded by hospital discharge data in Massachusetts in 2012 (see Graph 2.1).
A total of 2,540 lower-limb amputations were performed in 2012. Almost half of these involved the toes (48.1 percent), followed by partial foot amputations (15.1 percent). Below-knee amputations accounted for 20.5 percent and above-knee amputations accounted for 14.5 percent of the lower-limb amputation procedures performed in the state in that year. (see Graph 2.2).
3. WHO LOSES A LIMB? (2012)
In 2012, most amputations in Massachusetts were performed on individuals aged 65-84 years old (43.8 percent) and those aged 45-64 years (38.8 percent) (see Graph 3.1). These trends largely reflect the aging population and causes of amputations resulting from dysvascular conditions, especially diabetes, which are more common in older individuals (1).
There were nearly 2.5 times more amputations performed on male patients in Massachusetts than on female patients (see Graph 3.2).
In 2012 most of the amputations in the state ofMassachusetts were performed on patients who were White (77.7 percent), African American (0.8 percent), or Hispanic (8.9 percent) (see Graph 3.3).
Many studies have published research that shows evidence for inequalities in terms of amputation incidence among minorities when compared to the proportion of amputations in the White population. A few studies offer suggestions for why this happens, such as certain ethnic populations being genetically more likely than others to experience diseases such as diabetes that can lead to amputation. Various socioeconomic factors and a population’s access to healthcare can also affect these numbers (4, 6, 7).
4. AMPUTATION COSTS
Paying for an amputation can place a large burden on the patient. For people with a unilateral lower-limb 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 people with a unilateral lower-limb amputation is estimated to be more than $500,000 (8).
Many factors contribute to the variation in healthcare costs for people with limb loss. Having a higher amputation level and multiple amputations can lead to increased costs for prosthetic devices. For example, the two-year healthcare costs for a person with an above-knee amputation are estimated to be $110,039, compared to $86,244 for a person with a below-knee amputation (8).
For 2012, the burden of costs associated with limb loss are largely experienced by Medicare, which paid for over half of the amputation procedures performed in the State of Massachusetts (see Graph 4.1).
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. Owings MF. Ambulatory Procedures in the US 1996. National Center for Health Statistics Vital Health Stat1998;13(139).
3. NCfHS CfDCaP. Number (in Thousands) of Hospital Discharges for Nontraumatic Lower Extremity Amputation with Diabetes as a Listed Diagnosis, United States, 1988–2009. 2012.
4. Dillingham TR. Limb amputation and limb deficiency: Epidemiology and recent trends in the United States. Southern Medical Journal2002;95(8):875-83.
5. Parker SE, Mai CT, Canfield MA, Rickard R, Wang Y, Meyer RE, Anderson P, Mason CA, Collins JS, Kirby RS, Correa A. Updated national birth prevalence estimates for selected birth defects in the United States, 2004-2006. Birth Defects Research Part A: Clinical and Molecular Teratology2010;88(12):1008-16.
6. Fisher ES. Disparities in health and health care among medicare beneficiaries. Dartmouth Atlas Project Report Commissioned for the Aligning Forces for Quality Program2008.
7. Lefebvre K. Disparities in amputations in minorities. Clinical Orthopaedics and Related Research2011;469(7):1941-50.
8. 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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