High Incidence of Ischemic Amputation in Minn. Supports Need for Surveillance

In the first population-based estimate of ischemic amputation at the state level, researchers found that the incidence of related lower limb amputation — the most serious consequence of critical limb ischemia — was high, resulting in major illness and health economic costs.

Critical limb ischemia (CLI) is the most severe manifestation of peripheral artery disease (PAD).

The study, funded by the Centers for Disease Control and Prevention, suggested that incidences of CLI will likely increase due to an aging population and the increasing prevalence of diabetes. Researchers aimed to create a surveillance methodology for the incidence of ischemic amputation in the state, as well as create an estimate of direct costs and economic burden associated with ischemic amputation as it relates to coronary heart disease (CHD).

The study looked at the incidence of ischemic amputation based on inpatient hospital discharges in Minnesota from Jan. 1, 2005, through Sept. 31, 2008.

Researchers classified amputations as major (at or above the ankle) or minor (below ankle). Of 4,302 hospitalizations for lower limb amputations, 1,831 (43%) were major and 2,470 (57%) were minor. Median patient age was 67 years; most amputations were performed on men and patients residing in a rural county. Of total amputations, the most (72%) were performed on patients with diabetes; 63% of patients who had a major amputation had diabetes.

The age-adjusted annual incidence of lower limb ischemic amputation during the period was 20 per 100,000 (95% CI, 19.4-20.6). The number of amputation-related hospitalizations held steady over the 4-year period.

The mean cost per hospitalization increased by 9.2% from 2005 through 2008. Median total cost for each amputation was $32,129; cumulative inpatient hospitalization chargers were $56.5 million in 2008. The median charge for ischemic amputation hospitalizations was similar to that for CHD and about twice as high for hospitalizations for those with stroke and transient ischemic attack. Researchers found that overall hospital resource allocation and economic burden was high for CLI, given that patients who underwent ischemic amputation had long hospital stays.

The researchers said that incidence of amputation mortality was not uniform across the state, likely reflecting different care standards for associated atherosclerotic conditions such as stroke, myocardial infarction and PAD, and that results demonstrated disparity of care affecting patients with CLI.

“Although the incidence of ischemic amputation in Minnesota is lower than has been reported from other studies, the direct inpatient hospital charges and estimated costs are high,” the researchers wrote. “Ischemic amputation represents a significant statewide cardiovascular disease burden compared with both CHD and stroke mortality.”

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