Letter to the Editor

Organized Programs to Prevent Lower-Extremity Amputations

To the Editor:

In the interesting article entitled “Organized Programs to Prevent Lower-Extremity Amputations” that was published in the March/April 2010 issue of JAPMA, the authors, Lee C. Rogers, DPM, and Nicholas J. Bevilacqua, DPM, inaccurately describe the trend in lower-extremity amputations in the United States. The article states, “In the United States, the age-adjusted lower-extremity amputation rate per 10,000 population has steadily increased from 2.0 in 1990 to 2.6 in 2003.” This information was obtained from the Centers for Disease Control and Prevention Web site.[1] A more accurate description of the data is a steady rise from 2.0 in 1990 to 3.1 in 1997, then steadily decreasing to 2.6 in 2003 and further to 2.4 in 2005. The article goes on to state, “. . .isolated centers are reporting successful reductions in diabetes-related amputations.” Yet, in a statewide study, South Carolina reported a 33% reduction in diabetes-related amputations between 1996 and 2002.[2] In a report covering all Veterans Affairs facilities, there was a reduction in the rate of amputations from 1989 to 1998.[3] A study of Agency for Healthcare Research and Quality data estimates that there was a more than 20% reduction in major amputation rates nationally from 1998 to 2003.[4] I would argue the data are much more optimistic than Drs. Rogers and Bevilacqua presented in their limited report.