We used data from the Agency for Healthcare Research and Quality’s Nationwide Inpatient Sample (NIS) to estimate hospital discharges involving nontraumatic lower extremity amputation (LEA) and diabetes by level of amputation. The Nationwide Inpatient Sample contains information on hospital inpatient stays from States participating in the Healthcare Cost and Utilization Project. The NIS provides annual information on approximately 5 million to 8 million inpatient stays from about 1,000 hospitals. The 2002 NIS contains a sample of hospitals comprising about 90 percent of all hospital discharges in the United States. A more detailed description of the NIS is available (1).

Hospital discharges for which diabetes (ICD-9 code 250) was any listed diagnosis were used to examine discharges involving LEA. Cases were defined as discharges having diabetes as a listed diagnosis and an LEA procedure (ICD-9 procedure code of 84.1). Discharges with a traumatic amputation diagnosis code (ICD-9 diagnoses codes 895-897) were excluded. Discharges were categorized according to level of amputation using ICD-9 procedure codes – toe (ICD-9 code of 84.11), foot (ICD-9 codes 84.12-84.13), below knee (ICD-9 codes 84.14-84.16), and above knee (ICD-9 codes 84.17-84.19). LEA hospital discharge rates by amputation level were calculated using estimates of the population with diabetes from CDC’s National Health Interview Survey.

Data Limitations

Because NIS data represent hospital discharges and not individual persons, patients with multiple LEA hospitalizations could be counted multiple times. The NIS underestimates the total number of LEA discharges because it does not include LEAs occurring in federal hospitals and outpatient settings. Race-specific discharges are underestimated and may be biased because a substantial proportion of discharges are missing racial classification (2).

References

NIS Technical Documentation. June 2004. Agency for Healthcare Research and Quality, Rockville, MD. (Accessed January 20, 2005 at http://www.ahrq.gov/data/hcup/nis.htm)
Agency for Healthcare Research and Quality and Centers for Disease Control and Prevention. Hospital discharge rates for nontraumatic lower extremity amputation by diabetes status--United States, 1997. MMWR 2001;50(43):954-8.

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This page last reviewed December 20, 2005.

United States Department of Health and Human Services
Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Division of Diabetes Translation