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