Analysis Of Oklahoma Amputation Trends and Identification of Risk Factors to Target Areas For Limb Preservation Interventions

Background Annual trends of lower extremity amputation due to end-stage chronic disease are on the rise in the United States. These amputations are leading to massive expenses for patients and the medical system. In Oklahoma, we have a high-risk population because access to care is low, the number of uninsured is high, cardiovascular health is poor, and our overall healthcare performance is ranked 50th in the country. But we know little about Oklahomans and their risk of limb loss. It is, therefore, imperative to look closely at this population to discover contemporary rates, trends, and state-specific risk factors for amputation due to diabetes and/or peripheral arterial disease (PAD). We hypothesize that state-specific groups will be identified as having the highest risk for limb loss and that contemporary trends in amputations are rising. To create implementable solutions to limb preservation, a baseline must be set. Study Design We conducted a 12-consecutive-year observational study using Oklahoma’s hospital discharge data. Discharges among patients 20 years or older with a primary or secondary diagnosis of diabetes and/or PAD were included. Diagnoses and amputation procedures were identified using ICD-9 and ICD-10 codes. Amputation rates were calculated per 1,000 discharges. Trends in amputation rates were measured by annual percentage changes (APC). Prevalence ratios evaluated the differences in amputation rates across demographic groups. Results Over 5,000,000 discharges were identified from 2008-2019. Twenty-four percent had a diagnosis of diabetes and/or PAD. The overall amputation rate was 12 per thousand discharges for those with diabetes and/or PAD. Diabetes and/or PAD-related amputation rates increased from 8.1 to 16.2 (APC: 6.0, 95% CI:4.7-7.3). Most amputations were minor (59.5%), and though minor increased at a faster rate compared to major (minor amputation APC: 8.1, 95% CI: 6.7-9.6 vs. major amputation APC: 3.1, 95% CI:1.5-4.7), major amputations were notable in that they were significantly increasing. Amputation rates were the highest among males (16.7), American Indians (19.2), uninsured (21.2), non-married patients (12.7), and patients between 45 and 49 years of age (18.8), and calculated prevalence ratios for each were significant (p=0.001) when compared within their respective category. Conclusion Amputation rates in Oklahoma have nearly doubled in 12 years, with both major and minor amputations significantly increasing. This study describes a worsening trend, underscoring that amputations due to chronic disease is an urgent statewide healthcare problem. We also present imperative examples of amputation healthcare disparities. By defining these state-specific areas and populations at risk, we have identified areas to pursue and improve care. These distinctive risk factors will help to frame a statewide limb preservation intervention.