Lower extremity amputations of US elderly population on the rise.

Abstract

Journal of the American Podiatric Medical Association Peripheral vascular disease is an increasing problem today. With the aging of the US population, the incidence of this disease will likely increase. Peripheral vascular disease can result in lower extremity amputation. Accordingly, modern medicine has increased efforts to treat this disease and its effects. New aggressive surgical procedures have evolved over the last 20 years. The rate of peripheral bypass procedures has increased dramatically. Less invasive surgical techniques, such as percutaneous angioplasty, have been developed. Educational programs to inform professionals and the public are becoming widespread. New medications have been developed to counter the pathology of peripheral vascular disease, and risk factors have been identified. In many studies, the number of lower extremity amputations has been used as the measure of the effectiveness of surgical procedures. These studies show a decrease in lower extremity amputation following the use of new surgical bypass indications or techniques. Unfortunately, many of these studies showing a decrease in these amputations are from single institutions. The studies are small in a geographical and numerical sense. When larger populations studies over a large geographical area are done, no decrease in lower extremity amputations is documented, despite increases in peripheral bypass and other procedures. In fact, all studies that show decreasing numbers of these amputations are small. Large studies, in both a numerical and geographical sense, show no decrease in lower extremity amputations. This study compared the numbers of such amputations billed to Medicare in 1983, 1990, and 1993, covering 12 randomly chosen states. An amputation rate for the elderly was calculated and the study found no decrease in the lower extremity amputation rate in the elderly population despite aggressive medical and surgical intervention.