title: The incidence and health economic burden of ischemic amputation in Minnesota, 2005-2008.
abstract: BACKGROUND
  Critical limb ischemia (CLI) is the most severe manifestation of peripheral artery disease (PAD), is associated with high rates of myocardial infarction, stroke, and amputation, and has a high health economic cost. The objective of this study was to estimate the incidence of lower limb amputation, the most serious consequence of CLI, and to create a surveillance methodology for the incidence of ischemic amputation in Minnesota.
  
  
  METHODS
  We assessed the incidence of ischemic amputation using all inpatient hospital discharge claims in Minnesota from 2005 through 2008. We identified major and minor ischemic amputations via the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure codes for lower limb amputation not due to trauma or cancer and assessed geographic and demographic differences in the incidence of ischemic amputation.
  
  
  RESULTS
  The age-adjusted annual incidence of lower limb ischemic amputation in Minnesota during the 4-year period was 20.0 per 100,000 (95% confidence interval, 19.4-20.6). Amputations increased significantly with age, were more common in men and in people with diabetes, and were slightly more common in rural residents. The number of amputation-related hospitalizations was steady over 4 years. The median total charge for each amputation was $32,129, and cumulative inpatient hospitalization charges were $56.5 million in 2008.
  
  
  CONCLUSIONS
  The incidence of ischemic amputation is high and results in major illness and health economic costs. These data represent the first population-based estimate of ischemic amputation at the state level and provide a national model for state-based surveillance.
authors: Center for Health Promotion, Health Promotion and Chronic Disease Division, Minnesota Department of Health, PO Box 64882, St. Paul, MN 55164-0882, USA. james.peacock@state.mn.us
authors: James M
authors: JM
authors: Peacock
authors: Hong H
authors: HH
authors: Keo
authors: Sue
authors: S
authors: Duval
authors: Iris
authors: I
authors: Baumgartner
authors: Niki C
authors: NC
authors: Oldenburg
authors: Michael R
authors: MR
authors: Jaff
authors: Timothy D
authors: TD
authors: Henry
authors: Xinhua
authors: X
authors: Yu
authors: Alan T
authors: AT
authors: Hirsch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D003365:Costs and Cost Analysis; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D015994:Incidence; D007345:Insurance Claim Review; D007511:Ischemia / Q000191:economics* / Q000453:epidemiology / Q000601:surgery; D007866:Leg / Q000098:blood supply* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D058729:Peripheral Arterial Disease / Q000191:economics* / Q000453:epidemiology / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors