Nontraumatic amputation: incidence and cost analysis

Lower extremity amputation (LEA) is devastating for those affected and a significant factor in health care costs. Although the overall incidence of amputation has been declining, the decline is not universal. The objectives of this study were to identify patients with nontraumatic amputation at Harbor-UCLA Medical Center (HUMC) from January 2000 to January 2007, to calculate their 1-year and 5-year mortality rates after amputation and to estimate the financial cost of those amputations. The authors searched the HUMC electronic database by ICD codes (84.10-84.18) to identify patients with LEA and subsequently searched the National Death Index database for deaths in study subjects to calculate mortality rates. HUMC is a Los Angeles County tertiary teaching medical center that provides medical care to a large percentage of the Los Angeles County population, especially those without health insurance. There were 1169 admissions in 847 patients with nontraumatic LEA with a 1-year mortality rate of 9.1% and 5-year mortality rate of 25.6%. Only major amputation and increasing age were independent risk factors for 1-year mortality rate. At 1 year, the re-amputation rate for nontraumatic LEA was 26.7%. African American and Hispanic females had a significantly higher percentage of major amputations than corresponding males and white females. The average length of hospital stay was more than double for patients with nontraumatic amputation than for all other admissions (12.7 vs 5.3 days). There were 14,846 hospital days for 1169 nontraumatic amputation admissions with an estimated cost of $47,033,767. Amputation remains common at HUMC and the associated mortality rates and economic costs are high. In the authors' opinion, a coordinated and serious campaign by all involved in the health care system is urgently needed to implement proven and effective measures such as establishing multidisciplinary foot care clinics to reduce amputation.