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Perspectives in Circulation Today
National Diabetes Surveillance System
Hospitalizations for Nontraumatic Lower Extremity Amputation
Age-Adjusted Hospital Discharge Rates for Nontraumatic Lower Extremity Amputation per 10,000 Population, United States, 1980-2002
The age-adjusted rate of hospital discharge for nontraumatic lower extremity (LEA) per 10,000 population increased after the 1983 implementation of the prospective reimbursement system by the Center for Medicare and Medicaid Services, leveled off during the mid-to-late 1980s, and then began increasing in the early 1990s. After peaking in 1996, LEA rates showed little change. In 2002, the age-adjusted LEA rate (2.9 per 10,000 population) was almost twice that of the rate in 1980 (1.6 per 10,000 population).
The rise in the amputation rate in the 1980's occurred in spite of the spread of bypass procedures. Likewise, the rise in the 1990's and its persistence through the most recent data occurred in spite of the spread of angioplasty and stent procedures. Again, these increases have occurred in spite of newer methods to control risk factors such as hypertension, hyperlipidemia and hyperglycemia. The epidemic of obesity and our lack of exercise remain relevant problems perhaps as much as anything explaining the curve above. For more on the epidemiology of amputations see www.circulatorboot.com/literature/epidemio.html. For information on the relationship of obesity to the metabolic syndrome see www.circulatorboot.com/literature/clotting.html , beginning with Facchini et al through Fernandez-Real.