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Reamputation, mortality, and health care costs among persons with dysvascular lower-limb amputations

https://doi.org/10.1016/j.apmr.2004.06.072Get rights and content

Abstract

Dillingham TR, Pezzin LE, Shore AD. Reamputation, mortality, and health care costs among persons with dysvascular lower-limb amputations.

Objectives

To examine 12-month reamputation and mortality rates as well as acute and postacute medical care costs among a large cohort of persons with dysvascular amputations.

Setting

General community.

Participants

Medicare beneficiaries identified from the Centers for Medicare and Medicaid Services data as undergoing a lower-limb amputation secondary to vascular disease in 1996.

Interventions

Not applicable.

Main outcome measures

Twelve-month reamputation and mortality rates, and acute and postacute medical care costs, by initial amputation level and presence or absence of diabetes.

Results

A total of 3565 persons, corresponding to 71,300 Medicare beneficiaries nationwide, were identified from the claims data as undergoing lower-limb amputations in 1996. Twenty-six percent of them required subsequent amputation procedures within 12 months, and more than one third died within 1 year of their index amputation. Acute and postacute medical care costs associated with caring for beneficiaries with a dysvascular amputation exceeded $4.3 billion yearly. There were marked differences in patient characteristics, progression of amputation to higher levels, service use, and mortality among dysvascular amputees with and without a comorbidity of diabetes. Diabetic amputees were younger than those without diabetes; they were also more likely to be men, to have more comorbidities, and to have undergone their first amputation at an earlier age than persons with dysvascular amputations who did not have diabetes. Although diabetic amputees were less likely to die within 12 months of the index amputation, they died at a significantly younger age than their nondiabetic counterparts. Progression to a higher level of limb loss occurred most frequently (34.5%) among persons with an initial foot or ankle amputation. Diabetic amputees were more likely than nondiabetic amputees to experience progression to a higher amputation level for all initial amputation levels.

Conclusions

This study provides information that can be used by physicians when counseling patients about expected outcomes of dysvascular amputations at different levels.

Section snippets

Data sources

Data from the Center for Medicare and Medicaid Services (CMS; formerly the Health Care Finance Administration) Medicare claims files for 1996 and 1997 were used to develop estimates of dysvascular amputation and reamputation rates in the United States. These data represent the inpatient and outpatient health care experience of Medicare beneficiaries nationwide. Both acute and postacute care services, including number, intensity, and type of services received on both an inpatient and outpatient

Sample characteristics

A total of 3565 persons in the 5% random Medicare sample, corresponding to 71,300 Medicare beneficiaries nationwide, were identified from the claims data as undergoing lower-limb amputations in 1996. Of those, 2643 (74%, or 52,860 beneficiaries) had diabetes.

Table 1 presents the distribution of the sample, by presence or absence of diabetes, according to sociodemographic and amputation-related characteristics. The mean age of respondents was 73.7 years old, ranging from 21 to 107 years old in

Discussion

This study examined patterns of reamputation, mortality, and medical care costs among a nationally representative sample of persons with limb loss secondary to dysvascular disease. An estimated 71,300 Medicare beneficiaries (or 18.1/10,000 beneficiaries) underwent a dysvascular amputation in 1996. Twenty-six percent of these beneficiaries required subsequent amputation procedures within a 12-month period, and more than one third died within 1 year of their index amputation. Acute and postacute

Conclusions

This study provides information that can be used by physicians when counseling patients about expected outcomes of dysvascular amputations at different levels. In general, the reamputation rates reported here are lower than previously published figures and suggest more favorable clinical courses for persons with toe and transtibial amputations than those reported in earlier, smaller studies. Efforts should be directed at optimizing the level of the initial amputation, particularly among persons

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Supported by the National Institutes of Health, National Institute of Child Health and Human Development, and the National Center for Medical Rehabilitation Research (grants no. R29HD36414, R01HD36414).

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the author(s) or on any organization with which the author(s) is/are associated.

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