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Amputation rates rising in elderly despite treatment advances

A new study sponsored by the Agency for Health Care Policy and Research (HS07184) says older Americans with advanced lower-extremity vascular disease are at increasing risk of one day needing leg or foot amputation. Narrowed leg arteries reduce the flow of oxygen-rich blood, and therefore increase the risk of infections and life-threatening gangrene. According to the researchers, who were led by Joe Feinglass, Ph.D., of Northwestern University, the increase appears to be the result of factors such as limited growth in hospitals' capacity to perform lower-extremity bypass surgery and angioplasty (a procedure for widening blocked arteries), the increasing longevity of elderly patients with cardiovascular disease, and the steady prevalence of diabetes mellitus, which contributes to vascular disease and can cause dangerous foot ulcers.

The researchers, who looked at population-based rates of above- and below-the-knee amputation procedures for Americans by age, sex, and other factors between 1979 and 1996, found that rising rates of amputation at the beginning of the study period were initially reversed following the introduction in the early 1980s of surgical procedures for dilating or bypassing blocked leg arteries. A decline in the prevalence of hypertension, ischemic heart disease, and smoking also contributed to this reversal. However, by the mid-1990s, the downward trend flattened out and amputation rates began rising again. By 1996, the latest year analyzed by the researchers, the combined rates for above- and below-the-knee amputations were 11 percent higher than they had been in 1979. Also in 1996, approximately 76,000 above- and below-the-knee amputations were performed in the United States, compared with an annual average of 54,000 procedures over the 17-year study period.

The study, which was also supported by the National Heart, Lung, and Blood Institute, was based primarily on information from the National Center for Health Statistics' National Hospital Discharge Survey and National Health Interview Survey.

Details are in "Rates of lower extremity amputation and arterial reconstruction in the United States, 1979," by Dr. Feinglass, Jacqueline L. Brown, M.D., Anthony LoSasso, Ph.D., and others, in the August 1999 issue of the Journal of the American Public Health Association 89, pp. 1222-1227.

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