Declines in lower extremity amputation in the US Medicare population, 2000-2010.
BACKGROUND
Despite evidence that improved outcomes are associated with more distal lower extremity amputations (LEA), the impact of recent advances in the orthopedic approach to diabetic foot ulcer (DFU) on the use and anatomic level of LEAs is unknown.


METHODS
We queried the complete Medicare Part B claims database (2000-2010) for volume and reimbursement of all codes designating LEAs (hip and below) as well as a selection representing orthopedic treatments for DFU. Procedures were grouped for analysis; utilization rates per 100,000 Medicare enrollees and compound annual growth rates (CAGRs) of payments were calculated. Data are presented in the context of national health care spending trends.


RESULTS
LEA utilization rates declined from 282.5 to 201.0 per 10(5) enrollees (-28.8%) over the decade. In general, declines were greatest for the most proximal levels and smallest for the most distal sites. Use of orthopedic treatments for DFUs, including Achilles tendon release and total contact casting, rose from 26.0 to 63.3 per 10(5) enrollees (+143.3%). Payment trends mirrored utilization data. During this period, total health care spending in the United States increased at a CAGR of 6.5%, whereas total Medicare payments rose at a CAGR of 8.9%.


CONCLUSION
The last decade saw a marked decline in the use of LEA in the Medicare population, despite unfavorable demographic changes. Furthermore, it became more likely for LEAs to occur at distal, limb-conserving locations. Over the same period, use of orthopedic treatments for DFU increased sharply.


LEVEL OF EVIDENCE
Level III, retrospective comparative database analysis.
['Belatti|Daniel A|DA|', 'Phisitkul|Phinit|P|']
D000368:Aged D000671:Amputation D017719:Diabetic Foot D005260:Female D006801:Humans D007345:Insurance Claim Review D035002:Lower Extremity D008297:Male D016345:Medicare Part B D010818:Practice Patterns, Physicians' D012189:Retrospective Studies D014481:United States
diabetes biomechanics outcome studies statistical analysis tendon disorders