Updated 3/2019 | Download PDF
INTRODUCTION
Currently, 1.9 million people are living with limb loss in the United States (1). An estimated 185,000 amputations are performed each year (2). The number of people living with limb loss is expected to double by the year 2050 due to increasing rates of diabetes and vascular disease (3). Among those living with limb loss, the major causes of amputation are vascular disease (54%) – including diabetes and peripheral arterial disease – trauma (45%) and cancer (less than 2%) (4). The most common causes of pediatric amputations, however, are lawn mower accidents (5). Non-whites comprise about 42% of the limb loss population in the U.S. (3). In 2008, the diabetes related amputation rate among African Americans was nearly four times that of whites (6).
A total of 3,786 amputations were performed in Tennessee hospitals in 2014. These amputations were performed for a variety of reasons, including diabetes. The following information highlights the trends and most current rates of amputation and diabetes in Tennessee.
1. AMPUTATION TRENDS OVER TIME
There was an overall 6.38% increase in total amputations performed in Tennessee from 2001-2014 according to hospital discharge data. A total of 46,727 amputation procedures were performed in this time period. The lowest incidence of amputation (3,358) was in 2009. After dropping to 3,475 in 2012, the incidence of amputation climbed to 4,019 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 increased 18.64% from 2001 to 2014. A total of 3,590 upper-extremity amputation procedures were performed in this time period. The lowest incidence of these amputations (230) occurred in 2003, while 2007 saw the most upper-extremity amputations (307). (See Graph 1.2)
The number of lower-extremity amputations performed each year increased 6.40% from 2001 to 2014. A total of 46,208 lower-extremity amputation procedures were performed in this time period. The lowest incidence of these amputations (3,107) occurred in 2009. After the highest incidence year in 2011 (3,513), lower-extremity amputation procedures had been steadily declining until 2014 with 3,738 amputation procedures and another peak in frequency. (See Graph 1.3)
Source: Healthcare Cost and Utilization Project HCUPnet database hcupnet.ahrq.gov/
2. TYPES OF AMPUTATIONS PERFORMED
There were 261 upper-extremity amputations were performed in 2014. The most common minor upper-extremity amputations were of the fingers (202) and the most common major upper-extremity procedures were above the elbow (20). (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/
In 2014, 3,724 lower-extremity amputations were performed. Amputations of the toes (1,626) were the most frequent minor lower extremity amputation type. Below (914) and above (703) the knee were the most common major lower extremity amputation procedures. (See Graph 2.2)
3. WHO LOSES A LIMB?
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).
Source: Healthcare Cost and Utilization Project HCUPnet database hcupnet.ahrq.gov/
Source: Healthcare Cost and Utilization Project HCUPnet database hcupnet.ahrq.gov/
The amputation rate among males was twice that of females (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/
In 2014, 76.24% of amputation procedures were performed on Whites. However, African-Americans experienced 20.80% of the amputation procedures performed in 2014 despite comprising 16.8% of the population of the state of Tennessee.
4. AMPUTATION COSTS
Diabetes is a leading cause of lower-extremity amputations.
In 2014, a total of 657,979 Tennesseans indicated that they had been diagnosed with diabetes at some point in their lives. The prevalence of diabetes in the adult population of Tennessee increased 222.06 % from 1994 to 2014. (See Graph 4.1)
Source: CDC Behavioral Risk Factor Surveillance System gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html
Source: CDC Behavioral Risk Factor Surveillance System gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html
The annual rate of existing cases of diabetes among adults in Tennessee increased 108.93% from 1994 to 2014. (See Graph 4.2)
5. HEALTHCARE COSTS
Diabetes is a leading cause of lower-extremity amputations.
In 2014, a total of 657,979 Tennesseans indicated that they had been diagnosed with diabetes at some point in their lives. The prevalence of diabetes in the adult population of Tennessee increased 222.06 % from 1994 to 2014. (See Graph 4.1)
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. Arch Phys Med Rehabil2008 Mar;89(3):422-9.
- Adams PF, Hendershot GE, Marano MA. Current estimates from the National Health Interview Survey, 1996. Vital and health statistics Series 10, Data from the National Health Survey1999 Oct(200):1-203.
- 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 Feb;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.
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