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

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. Although 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 extremities vary across the United States is unknown.

METHODS

Evaluation of Medicare beneficiaries who underwent lower extremity amputation between 2015 and 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. The average age (SD) was 74 years (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%, whereas the highest quintile demonstrated 90%. The median travel distance in the lowest emergency surgery rate quintile was 34.6 miles compared with 10.5 miles in the highest quintile of emergency surgery ( P < 0.001).

CONCLUSIONS

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 of amputation have an inverse relationship, suggesting that barriers other than travel distance are playing a role.

A collaborative and comprehensive approach to women’s musculoskeletal health

This article was migrated. The article was not marked as recommended. Background: The passage of Title IX precipitated a rise in the number of female athletes, an increase in musculoskeletal injuries observed in women, and an understanding that sex disparities in musculoskeletal injuries exist. Women's musculoskeletal health programs have been created to develop sex-specific strategies to prevent and treat musculoskeletal injuries in women. The purpose of this report is to highlight the formative process of a comprehensive Women's Musculoskeletal Health and Sports Medicine Program. Methods: A half-day workshop of research presentations and networking was a preliminary step in the formative process of establishing a Women's Musculoskeletal Health and Sports Medicine Program. This workshop was aimed at facilitating communication and collaboration between subspecialties. Following the workshop, a survey was distributed to assess attendees' impressions of the workshop. Results: Nine of 11 (81.8%) respondents strongly agreed that the workshop was informative and 8 of 11 (72.7%) strongly agreed that they learned something new. Ten of 11 (90.9%) respondents strongly agreed that they would attend a similar workshop in the future. Conclusions: An event focused on defining sex disparity in musculoskeletal injuries, highlighting current research in women's musculoskeletal health, and encouraging networking among health care providers seems to be an effective means of laying the groundwork for the development of a formal comprehensive musculoskeletal health and sports medicine program for women and girls.