Objective: CDC’s recent data (Harding et al. 2020) showed that rates of major lower-extremity amputations (ankle or above) rapidly decreased in 2000 - 2010 and then stabilized at slightly lower than 0.1% of Medicare beneficiaries with diabetes since then. We examined the commonwealth of Kentucky (KY) inpatient data to track trends in diabetic major amputations in 2008 - 2018.
Methods: We used KY HCUP inpatient data to identify all patients with diabetes using ICD9/10 codes and those who have underwent major amputations using CPT codes.
Results: The number of hospitalizations by patients with diabetes in KY decreased by 8% in 2008 - 2018 but the number of major amputations increased from 560 to 795 limbs, representing a 42% increase in the same period. Medicare paid for 44% of these surgeries in 2008 and 61% in 2018, while Medicaid covered 38% in 2008 but only 31% in 2018 despite the expansion in Medicaid coverage since 2014. KY inpatient users with diabetes had 46% higher odds of having a major amputation in 2018 compared to those in 2008, adjusting for age, sex, and race/ethnicity. Compared to pre-2014 era, the odds of having a major amputation was 27% higher after the Medicaid expansion in 2014.
Conclusion: It is concerning that, while the rest of the country showed decreasing or stationary trends in major amputation rates, KY experienced continuously increasing number of major amputations in the last two decades. Although Medicaid expansion era had a significantly higher odds of major amputations compared to the pre-expansion era, it is not clear whether this reflects the effect of policy or is part of a secular trend since 2010. More careful analysis is needed to better understand the underlying causes of this trend and what needs to done to reverse it.
M. Sohn: None. W. Kim: None. M. Lacy: None.