There are an estimated 1.9 million people living with limb loss in the United States, a number that is expected to double by 2050, largely due to the rising diabetes epidemic.
Approximately 185,000 major amputations are performed a year and 70,000 are for peripheral artery disease (PAD).
Patients undergoing amputation for PAD suffer from severe circulation problems or end stage PAD known as critical limb ischemia (CLI).
Not all limbs can be salvaged, but the World Health Organization estimates that 85% of amputations are preventable.
Risks Associated With Amputations
At least half of patients who have foot amputations die within five years – a mortality rate that is worse than most cancers.
5-10% of below the knee amputations (BKA) and 15-20% of above the knee amputations (AKA) die in the hospital before discharge.
Wound complications occur after amputations in 10-30% which if not resolved can lead to amputation at a higher level.
Other serious complications after amputations that include blood clots (13–26%), cardiac complications (9–10 %), bleeding (8%) and kidney failure (2–3 %)
Chronic pain is experienced by almost all amputees. This includes phantom limb pain which occurs at a rate of 80%, but also residual limb pain and up to 74%.
Personal Impact on the Individual
Limb loss is a potentially devastating event in a person’s life, often resulting in profound physical, psychological, and vocational consequences.
Amputees perceive themselves to be severely impaired with ambulation, body care, movement and mobility. One third or more experience depression.
In a study of all major lower limb amputees in 65-year-olds or older only a third of patients were successfully fitted for prosthesis.
In a recent review, nursing home patients undergoing BKA or AKA failed to return to the functional baseline within 6 months.
Causes of Amputation
- PAD (peripheral arterial disease) – leads to poor circulation because of narrowing of the arteries. Without adequate blood flow, the affected tissue begins to die and infection may set in.
- Diabetes – (due to a combination of decreased sensation in the feet, decreased ability to fight infection and increased risk of poor circulation)
- Neuropathy – condition of the nerves that causes numbness and loss of sensation
- Congenital or birth defects
Amputation is Costly
The macroeconomic cost of amputation is estimated at $ 10.6 billion.
Two major studies have shown amputation to be less cost-effective than either surgical bypass or endovascular revascularization.