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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 3,115 amputations were performed in South Carolina 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 South Carolina.
1. AMPUTATION TRENDS OVER TIME
Source: Healthcare Cost and Utilization Project HCUPnet database hcupnet.ahrq.gov
The number of total amputations performed in South Carolina increased 9.61% from 1997 to 2013 according to hospital discharge data. A total of 51,176 procedures were performed in this time period. After a low of 2,741 in 2008, the number of amputation gradually rose again to 3,115 in 2013. (See Graph 1.1)
The number of upper-extremity amputations performed each year ultimately increased 9.52% from 1997 to 2013. A total of 2,902 of these procedures were performed in this time period. The lowest incidence of these amputations (125) occurred in 2009, while 2000 saw the most upper-extremity amputations (208) in this time period. (Graph 1.2)
Source: Healthcare Cost and Utilization Project HCUPnet database hcupnet.ahrq.gov
Source: Healthcare Cost and Utilization Project HCUPnet database hcupnet.ahrq.gov
From 1997 to 2013, a total of 48,274 lower-extremity amputations were performed in South Carolina. The numbers reached their lowest at 2,580 in 2008. The numbers of amputations were at their highest at 3,070 in 2000. This is still a 9.61% increase from the number of lower-extremity amputations performed (See Graph 1.3)
2. TYPES OF AMPUTATIONS PERFORMED
147 upper-extremity amputations were performed in 2013. The most common minor upper-extremity amputations were of the fingers (123) and the most common major upper-extremity procedures were above the elbow (11). (See Graph 2.1)
Source: Healthcare Cost and Utilization Project HCUPnet database hcupnet.ahrq.gov
Source: Healthcare Cost and Utilization Project HCUPnet database hcupnet.ahrq.gov
2,929 lower-extremity amputations were performed in 2013. In terms of minor lower-extremity amputations, toes (1,207) were amputated more often than part of the foot (285). For major lower-extremity amputations, below-knee (742) amputation was the most common procedure. (See Graph 2.2)
3. WHO LOSES A LIMB?
In 2012, 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).
Source: Healthcare Cost and Utilization Project HCUPnet database hcupnet.ahrq.gov
Source: Healthcare Cost and Utilization Project HCUPnet database hcupnet.ahrq.gov
There were nearly 2 times more amputations performed on male patients in South Carolina 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).
Source: Healthcare Cost and Utilization Project HCUPnet database hcupnet.ahrq.gov
Source: Healthcare Cost and Utilization Project HCUPnet database hcupnet.ahrq.gov
We can see that the African American population of South Carolina bears the heaviest burden of amputation (0.113% of the African American population underwent amputations). This is evident when compared with the percentage of the white population that underwent amputations (0.050%), and with amputations in the state’s population as a whole (0.065%). (See Graph 3.4)
4. DIABETES TRENDS
Diabetes is a leading cause of lower-extremity amputations.
In 2013, a total of 460,464 South Carolina residents indicated that they had been diagnosed with diabetes at some point in their lives. The prevalence of diabetes in the adult population of South Carolina increased202.6% from 1994 to 2013. (See Graph 4.1
Source: CDC Behavioral Risk Factor Surveillance System apps.nccd.cdc.gov
Source: CDC Behavioral Risk Factor Surveillance System apps.nccd.cdc.gov
The annual rate of existing cases of diabetes among adults in Oregon increased 118.4% from 1994 to 2013. (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 (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)
Source: Healthcare Cost and Utilization Project HCUPnet database hcupnet.ahrq.gov
Source: Healthcare Cost and Utilization Project HCUPnet database hcupnet.ahrq.gov
Charges represent what the hospital billed for the case, and may not represent all discharges for amputations. (See graph 5.2)
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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