Long-term trends in major amputations for the state of Pennsylvania.

INTRODUCTION: Recent reports have suggested that the incidence of major amputations in the United States may be increasing. Despite the rapidly increasing use of closed vascular surgery and major improvements in diabetes management and medications, patients with diabetes mellitus in rural or distressed communities continue to experience a disproportionately high number of major amputations. Identification of the specific areas and populations at risk is urgently needed to address the disparity and rising incidence of a totally preventable devastating health outcome. This population-based study using an all-payer dataset provides a most recent assessment of major amputations in Pennsylvania.

METHOD: The state of Pennsylvania hospital inpatient database was accessed to capture major amputations with a peripheral arterial disease/chronic limb-threatening ischemia diagnosis from 2010 to 2023.

RESULTS: There were 25,645 unique patients in our cohort. The number of patients with major amputation increased modestly at 1.3% yearly. The major amputation rate increased from 2.1 per 10,000 to 2.5 per 10,000. The average age at amputation decreased over time.

CONCLUSIONS: The rate of major amputations in Pennsylvania increased modestly. Black men in distressed communities had a disproportionately high rate of amputation at increasingly younger ages. More states need to identify the populations and geographic areas with high rates of major amputation to enable a better understanding of the overall increase in major amputations in the United States. These studies need to use a standard cohort selection scheme and reporting method to allow a meaningful understanding of the populations at risk of major amputation.