Rising amputation rates, especially among opioid-related hospitalizations

1. In this cross-sectional study, amputation rates increased more rapidly among opioid-related than among non-opioid-related hospitalizations across the United States between 2016 and 2022.

2. At the regional level, the increase in amputation rates was also greater among opioid-related hospitalizations compared with non-opioid-related hospitalizations in the Northeast and West census regions.

Evidence Rating Level: 3 (Average)

Study Rundown: Injection drug use is associated with infections of the skin, soft tissue, and bone that may progress to severe complications requiring amputation. This study evaluated temporal changes in amputation rates among opioid-related hospitalizations at both national and regional levels. Between 2016 and 2022, approximately 41 million hospitalizations were recorded, of which 3.0% were opioid-related. Crude amputation rates increased across the United States in both opioid-related and non–opioid-related hospitalizations. However, the increase was more marked among opioid-related admissions, rising from 55.6 to 92.3 amputations per 10,000 hospitalizations. Regional analyses showed that this upward trend was more pronounced among opioid-related hospitalizations in the Northeast and West census divisions, as well as in the New England and Pacific regions, compared with non–opioid-related hospitalizations. Opioid-related hospitalizations were also associated with a higher proportion of more proximal amputations, including those of the upper extremity and at or above the knee or lower leg. Although these findings are limited by the inability to directly link individual opioid use to amputations and the potential for unmeasured confounding, they suggest a disproportionate rise in amputation rates among opioid-related hospitalizations. Overall, while amputation rates increased across all hospitalizations from 2016 to 2022, the increase was notably greater in opioid-related cases, particularly in the Northeastern and Western United States.

Click to read this study in AIM

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In-Depth [cross-sectional study]: This cross-sectional study evaluated trends in crude amputation rates among opioid-related and non-opioid-related hospitalizations at national and regional levels using data from the National Inpatient Sample. The study included hospitalizations from 2016 to 2022 among patients aged 18 years or older. A total of 41,010,691 unweighted hospitalizations (205,053,364 weighted) were identified, of which 3.0% were opioid-related. Among opioid-related hospitalizations, the mean age was 50.3 years, 49.8% were men, 70.3% were non-Hispanic White, 14.1% were non-Hispanic Black, and 8.8% were Hispanic. Among non-opioid-related hospitalizations, the mean age was 58.3 years, 42.7% were men, 64.4% were non-Hispanic White, 15.0% were non-Hispanic Black, and 11.4% were Hispanic. Crude amputation rates increased nationally and across all census regions in both groups. However, the increase was greater among opioid-related hospitalizations, rising from 55.6 to 92.3 amputations per 10,000 hospitalizations (crude rate difference, 36.7; standardized rate difference, 34.7 [95% confidence interval [CI], 27.8-41.5]). In comparison, non–opioid-related hospitalizations increased from 58.9 to 79.7 per 10,000 hospitalizations (crude rate difference, 20.8; standardized rate difference, 21.5 [95% CI, 19.7-23.3]). Standardized difference-in-differences analyses showed greater increases in amputation rates among opioid-related hospitalizations versus non–opioid-related hospitalizations at the national level (13.2 [95% CI, 6.4-19.9]), as well as in the Northeast (18.4 [95% CI, 4.4-32.4]) and West (19.1 [95% CI, 3.3-34.9]) census regions, and in the New England (22.9 [95% CI, 1.2-44.6]) and Pacific (21.5 [95% CI, 1.6-41.4]) divisions. Higher-level amputations were more common among opioid-related hospitalizations, including upper extremity (8.5% vs 5.2%), at or above the knee (17.9% vs 14.6%), and lower leg (25.7% vs 20.4%). Toe or partial foot amputations were less common (50.3% vs 61.7%). Overall, amputation rates increased more rapidly among opioid-related than non-opioid-related hospitalizations between 2016 and 2022 in the United States.

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