title: Declines in lower extremity amputation in the US Medicare population, 2000-2010.
abstract: 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%.
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  Level III, retrospective comparative database analysis.
authors: Caver College of Medicine, University of Iowa, Iowa City, IA 52242, USA.
authors: Daniel A
authors: DA
authors: Belatti
authors: Phinit
authors: P
authors: Phisitkul
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D017719:Diabetic Foot / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D035002:Lower Extremity; D008297:Male; D016345:Medicare Part B / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: biomechanics; diabetes; outcome studies; statistical analysis; tendon disorders