Amputations On the Decline In the US

Amputation rates have fallen in the past decade in the US

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Foot sores, or ulcers, are one of the many complications of diabetes. If these ulcers don't heal, a patient may need to have a foot or leg amputated, or surgically removed. Thankfully, it seems fewer people need these amputations.

A recent study found that both the number of lower limb amputations and the amount spent by Medicare for these surgeries have fallen during the past decade.

According to this study, one possible reason for the decrease in amputations may be that foot care for diabetes has improved.

"Check your feet daily if you have diabetes."

This study was conducted by Phinit Phisitkul, MD, and Daniel A. Belatti, BS, from the University of Iowa to examine trends in lower limb amputation in the US.

Lower limb amputations are performed for many reasons. They may be done to remove tumors or tissue damage from trauma or diabetes.

Though researchers know that the rate of these amputations has been decreasing, not many studies have examined this trend in detail.

For this study, the researchers looked at Medicare claims made for lower limb amputations and diabetic foot ulcer treatments over the ten year period between 2000 and 2010.

People with diabetes are at increased risk of developing foot ulcers. These ulcers can cause serious damage to tissue and bone, which may mean that a patient needs amputation of a toe, foot or part of a leg.

After looking at the claims data, the researchers found that in the year 2000, there were 111,520 lower limb amputations among Medicare patients. By 2010, this number fell to 93,640, a reduction of 16.3 percent.

The total amount paid by Medicare to doctors and hospitals for these amputations also fell by 20.4 percent, from $51.6 million in 2000 to $41 million in 2010.

The data also showed the amputations that occurred were more likely to be at the level of the toes rather than at the knee or ankle, thus saving most of the limb.

The number of individuals receiving Medicare coverage increased by 18 percent between 2000 and 2010, during which time the rates of risk factors for amputation — such as diabetes, hypertension and obesity — also increased. The researchers looked at this data to show that the drop in amputation rates occurred even though there was a rise in risks for amputation.

The authors noted a few limitations to their study, including the fact that the study data was restricted to Medicare patients. Also, the exact diagnosis for the cases was not known, so the number of diabetes cases among the study subjects was unknown.

Though the authors suggested that one of the causes for the lower rates of amputations could be the new advances in treating diabetic foot ulcers, they did not show that this was a direct cause.

"Further studies are required to determine the causes of the decrease in lower extremity amputation, which could be a combination of better preventive care, insulin control and the orthopedic treatments. More work is also required to determine the best practices in preventing lower limb amputation," said senior author Dr. Phisitkul in a press release accompanying the study.

The results of this study were published in July in Foot & Ankle International, the journal of the American Orthopaedic Foot & Ankle Society.

The study did not receive funding from any external sources. No conflicts of interest were reported.

Reviewed by: 
Review Date: 
July 11, 2013
Last Updated:
July 30, 2013