Rate of Emergency Lower Extremity Amputations in the United States among Medicare Beneficiaries

Ann Surg. 2023 Sep 27. doi: 10.1097/SLA.0000000000006105. Online ahead of print.


Objective: To determine the rate of emergency versus elective lower extremity amputations in the United States.

Background: Lower extremity amputation is a common endpoint for patients with poorly controlled diabetes and multilevel peripheral vascular disease. While the procedure is ideally performed electively, patients with limited access may present later and require an emergency operation. To what extent rates of emergency amputation for lower extremity vary across the United States is unknown.

Methods: Evaluation of Medicare beneficiaries who underwent lower extremity amputation between 2015-2020. The rate was determined for each zip code and placed into rank order from lowest to highest rate. We merged each beneficiary's place of residence and location of care with the American Hospital Association Annual Survey using Google Maps Application Programming Interface to determine the travel distance for patients to undergo their procedure.

Results: Of 233,084 patients, 66.3%(154,597) were men, 69.8%(162,786) were White. Average age(SD) was 74 year(8). There was wide variation in rates of emergency lower extremity amputation. The lowest quintile of zip codes demonstrated an emergency amputation rate of 3.7% while the highest quintile demonstrated 90%. Median travel distance in the lowest emergency surgery rate quintile was 34.6 miles compared to 10.5 miles in the highest quintile of emergency surgery (P<0.001).

Conclusion: There is wide variation in the rate of emergency lower extremity amputations among Medicare beneficiaries, suggesting variable access to essential vascular care. Travel distance and rate amputation have an inverse relationship, suggesting that barriers other than travel distance are playing a role.