“In today’s world, there is no excuse for routinely recommending primary major amputation for patients with uncomplicated diabetic foot ulcers and problems,” writes Dr. Terry Treadwell in the publication, Wounds. 1
Amputations are surprisingly common and often stereotypically viewed as a side effect of war, not a consequence of peripheral artery disease. Here are a few statistics about amputation, diabetes and Peripheral Artery Disease that will make you think again.
Limb Loss Statistics
- There are nearly 2 million people living with limb loss in the United States.2
- Among those living with limb loss, 54% are due to peripheral artery disease /diabetes.2
- 185,000 amputations occur in the United States each year.3
- In 2009, hospital costs associated with amputation totaled more than $8.3 billion.4
- African‐Americans are up to four times more likely to have an amputation than white Americans.5
- Amputations are more common in patients who have been heavy smokers.6
- Lower-limb ulcers are the most reliable harbingers of future amputation.7
- Patients With Diabetic Foot Disease Fear Major Lower-Extremity Amputation More Than Death.8
- Nearly half of the individuals who have an amputation due to PAD will die within 5 years. This is higher than the five-year mortality rates for breast cancer, colon cancer, and prostate cancer.9
- The rate of death after major amputation in the US is approximately 48% at 1 year and 71% at 3 years.10
- Of persons with diabetes who have a lower extremity amputation, up to 55% will require amputation of the second leg within 2‐3 years.11
- Without revascularization, up to 40% of patients with CLI will require lower limb amputation by 1 year.12
- Many patients greatly benefit from restoration of flow, which is required for wound healing and limb salvage to occur.13
If you or a loved one has been recommended an amputation, get a second option. There are options to help restore blood flow and save the limb.
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References:
- Treadwell, T. Amputation? Surely Not! Wounds. 2015: Aug;27(8)
- Ziegler‐Graham, et al. Estimating the Prevalence of Limb Loss in the United States: 2005 to 2050. Arch Phys Med Rehabil. 2008 Mar;89(3):422-9.
- Owings, et al. National Center for Health S. Ambulatory and Inpatient Procedures in the United States, 1996. Hyattsville, Md.: U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics; 1998.
- HCUP Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). Rockville, MD: Agency for Healthcare Research and Quality; 2009.
- Fisher ES, Goodman DC, Chandra A. Disparities in Health and Health Care among Medicare Beneficiaries: A Brief Report of the Dartmouth Atlas Project. Robert Wood Johnson Foundation2008.
- Jensen et al. The Prevalence of Chronic Critical Lower Limb Ischaemia in a Population of 20,000 Subjects 40–69 Years of Age. Eur J Vasc Endovasc Surg. 2006 Jul;32(1):60-5.
- Beckert, et al. A New Wound-Based Severity Score for Diabetic Foot Ulcers. Diabetes Care 2006; 29:988–992
- Wukich, et al. Patients With Diabetic Foot Disease Fear Major Lower-Extremity Amputation More Than Death. Foot Ankle Spec. 2018 Feb;11(1):17-21.
- Robbins, et al. Mortality rates and diabetic foot ulcers: is it time to communicate mortality risk to patients with diabetic foot ulceration? J Am Podiatr Med Assoc. 2008 Nov-Dec;98(6):489-93
- Swaminathan, et al. Lower extremity amputation in peripheral artery disease: improving patient outcomes. Vasc Health Risk Manag. 2014; 10: 417–424.
- Pandian G, Hamid F, Hammond M. Rehabilitation of the Patient with Peripheral Vascular Disease and Diabetic Foot Problems. In: DeLisa JA, Gans BM, editors. Philadelphia: Lippincott‐Raven; 1998.
- Shishehbor, et al. Critical Limb Ischemia: An Expert Statement. J Am Coll Cardiol 2016;68:2002–15
- Varu, et al. Critical Limb Ischemia. J Vasc Surg. 2010 Jan;51(1):230-41.