It isn’t a mistake that amputation infamously ranks among the top five surgical procedures in the United States. Compared to the seeming profusion of cancer screening methodologies, most hospitals in the United States lack enough screening infrastructure for PAD. These practitioners are not incentivized by the governing bodies to screen patients early enough in the disease process, thereby amplifying amputation risk later on.
Dr. Foluso Fakorede points to the fact that most clinical decisions in hospitals today are directly influenced at the top level by surgeons. These surgeons have choice places in medical committees, fill advisory capacities to CEOs and CFOs of hospitals, and are critical stakeholders in policy formulation.
With the bulk of the surgeons favoring surgical procedures, by virtue of their profession, the vascular specialist is relegated from being the first line of defense of people having risks of amputations. This explains the bulk of unnecessary amputations being jumped into by general-purpose practitioners.
Are amputations really that cheap?
According to Dr. Foluso Fakorede, such keenness to amputate can be attributed to the misrepresentation of amputations as being cheaper than preserving and healing the limb. The costs of amputations are high, both on the patient and the hospital. Dr. Foluso Fakorede breaks this cost into the clinical and economic variants. On the clinical side of things, patients who undergo amputation are more at risk of chronic pain. 80% of people who have amputations will experience phantom limb pain.
More interestingly, a hefty 37% of amputees suffer anxiety across their lives, with another 20% suffering from depression. It would have been a less bitter pill to swallow if the ills of amputation ended there. Still, amputation comes with the risk of increased mortality in patients, especially those with vascular diseases.
Do you know that almost half of the people with vascular diseases who get amputated die within 5 years? To better put this in context, this 5-year mortality rate beats that from prostate cancer, colon cancer, and even breast cancer. Studies further show that 55% of diabetics who undergo lower extremity amputation will need the second leg amputated within 2-3 years after the first procedure.
On the economic side, Dr. Foluso Fakorede asserts that these revisions could cost a single patient across his/her lifetime up to the tune of $500k. The economic costs also spill to the hospital. In 2009 alone, hospital expenditures on amputation cost over $8.3 billion. So do you now agree with us that the aptness to carry out amputations screams of shortsightedness on the part of hospitals?
What increases your risk of amputation?
Aside from diabetes, trauma, and PAD, certain conditions increase your disposition to being amputated in the United States. These risk factors include age, race, socioeconomic determinants, and access to health care. Let us tell you a bit about this.
Age
It is no revelation that elderly people (particularly the octogenarian class) are more prone to having amputations. Most practitioners inaccurately attribute pains in the lower extremities of older people to arthritis instead of poor circulation. This would lead such practitioners to adopt a surgical procedure instead of fundamentally ascertaining if a circulation blockade could be responsible.
Racial disparities
Not the most comforting truths, but black Americans, especially in the South have a higher risk of amputation.
Take Mississippi, for example. Reports show that there are 16.1 amputations per 1000 Black American patients in Tupelo and 14.2 in Meridian compared to 4.8 in Tupelo and 3.8 in Meridian for nonblack patients.
I will leave you to make your deductions, but I am not expecting you to deny that racial disparities influence one’s chances of amputation.