Leg, foot amputations increased 65% in Illinois hospitals between 2016-2023

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Leg, foot amputations increased 65% in Illinois hospitals between 2016-2023

Growing prevalence of diabetes and peripheral artery disease among patients

• Men, Black Americans, those living in areas with low socioeconomic status more affected
• The Illinois data from a diverse population (ethnic/racial, rural/metropolitan) likely reflects national amputation trends
• 'Unless we make changes in how we care for marginalized communities, I don't anticipate this getting better'

CHICAGO --- Rates of leg and foot amputations in Illinois hospitals increased 65% between 2016 and 2023, reports a new Northwestern Medicine study.

Men, Black patients, and those living in areas with low socioeconomic status were disproportionally affected, the study found. The dramatic spike is largely attributed to a growing prevalence of diabetes and peripheral artery disease (PAD), two chronic conditions that often lead to lower extremity amputation, the study authors said.

"Unfortunately, by the time a patient with diabetes and/or PAD presents with a foot wound or ascending leg infection, their disease might be just too advanced and amputation may be the only treatment option," said first author Dr. Maggie Reilly, a vascular surgery resident at McGaw Medical Center of Northwestern University. "The patient population with both diabetes and PAD had the biggest increase in amputation rates."

Rates of smoking have gone down in recent decades, and improvements in medical therapies, such as greater utilization of statin therapy, should theoretically improve limb salvage, she said. Those positive changes, however, are outpaced by the quickly increasing rates of diabetes and PAD, Reilly said.

"Despite our medical advances, we're not reaching all the communities that need it," Reilly said. "It's creating this bigger divide between people who are getting the necessary preventive care and those who aren't. Unless we make changes in how we care for marginalized communities, I don't anticipate this getting better."

The study was published today (Oct. 30) in the journal Diabetes Research and Clinical Practice.

Amputation burden: Shame, blame, months of healing

"The things that make a leg amputation necessary (diabetes and PAD) can also make it harder to heal," Reilly said. "The effects of those diseases don't stop with the amputation, which is really unfortunate."

Patients undergo at least three months of post-operative care that includes medical appointments to ensure proper healing, followed by months of physical and occupational therapy to learn how to walk on a prosthetic leg. Some patients need to wait six months before getting their prosthesis, Reilly said.

"Going six months without walking can really make patients debilitated," Reilly said. "It takes a big medical team to make sure patients get back to a level of independent functioning."

The mental burden of losing a limb also weighs on patients.

"People feel shame or they're looking for someone to blame. They can feel really disenchanted with the medical system and failed by their providers, but sometimes given the progressive nature of the disease, we've done everything we can do," Reilly said. "Patients generally have a poor understanding of diabetes and PAD, which makes it hard for them to come to terms with this life-changing procedure."

Illinois data likely reflects national rates of amputations

Approximately 150,000 non-traumatic leg amputations occur annually in the U.S. Although this study focused only on Illinois patients, the study authors said dramatic increases in leg and foot amputations are likely happening nationally.

"Using Illinois as a proxy for understanding amputation rates in the U.S. is helpful because Illinois has both metropolitan and rural areas, so it's a good snapshot of different communities," Reilly said. "We have a lot of racial and ethnic diversity, especially within Chicago, so we thought our data could be generalized nationwide."

What can be done?

Some data suggest that 50% of patients who undergo an above-knee amputation will die in the next 12 months because of the nature of systemic disease, Reilly said - which is why prevention and appropriate management of cardiovascular disease is of dire importance.

"We know from previous studies that PAD is underrecognized, underdiagnosed, and undertreated, especially for patients from marginalized populations," Reilly said. "Health systems and community partners should emphasize aggressive prevention including screening, early diagnosis and intensive risk factor management."

Breaking down the study findings

Between 2016 and 2023, there were 30,834 amputation admissions from 193 Illinois hospitals, with a 65% increase in annual amputation rate. Rates of diabetes and hospital stays that extended past 20 days also increased significantly. Amputees were disproportionately men, with only 28.8% of patients being women. The cohort included 20.2% of patients who were 75 years or older, and 25% of patients were non-Hispanic Black (as compared to an Illinois population with only 13.9% Black residents in 2020). During the study period, 81.5% of amputations occurred in patients with diabetes. The largest percent increases in amputation rates were for males (+76.1%), non-Hispanic Black patients (+67.5%) and residents aged 65 to 74 years old.

The study is titled, "A population health analysis of trends in lower extremity amputation secondary to diabetes and peripheral artery disease, 2016-2023." Other Northwestern study authors include Isabel Cohen, Samantha Watson, Dr. Karen Ho and Joe Feinglass.

Funding for the study was provided by the National Heart, Lung and Blood Institute of the National Institutes of Health (grant T32HL094293).