Lepow BD, Montero-Baker M, Pietzsch JB. Costs and Resource Burden of Major Lower Extremity Amputations in CLTI Patients. Symposium on Advanced Wound Care (SAWC) Fall 2024, Las Vegas, NV, Oct. 2, 2024.

Introduction. Limb salvage is critical in the care of patients suffering from chronic limb threatening ischemia (CLTI). Nevertheless, a substantial proportion of patients, particularly those considered ‘no- option,’ eventually undergo major lower extremity amputation (LEA). Our objective was to assess the costs and resource burden associated with hospital admissions for major LEA in CLTI patients.

Methods. The Medicare MedPAR 2022 inpatient hospital dataset was analyzed to identify all episodes of care with ICD-coded diagnosis of Rutherford grade 5/6 peripheral artery disease, concurrent coding of a major LEA procedure, and payment through one of the three major LEA Medicare severity-adjusted diagnosis related groups (MS-DRGs). The analysis population was stratified into cohort 1: consisting of ‘high anatomical complexity’ patients, defined as having a concurrent diagnosis code of chronic total occlusion which included patients who were considered ‘no-option’; and cohort 2: the remaining patients. Resource utilization, costs, and outcomes were reported, including in-hospital mortality, mean total length-of-stay (LOS) and intensive care unit (ICU) days, costs derived from charges, per-episode reimbursement amounts, and discharges to skilled nursing facility/inpatient rehabilitation.

Results. The analysis included 4,677 CLTI patients with major LEA, of whom 276 were cohort 1 patients. For cohort 1 and cohort 2, respectively, in-hospital mortality was 5.1% and 3.5%; LOS days were 16.6 and 13.7; ICU days were 2.9 and 2.4; costs were $42,063 and $32,706, while reimbursed amounts were $34,721 and $30,898; and 76.5% and 73.9% patients were discharged to skilled nursing facilities or inpatient rehabilitation care.

Discussion. Contemporary data from the Medicare population suggest hospitalizations for major LEA impose significant costs and resource burden in CLTI patients. This burden may be particularly pronounced in ‘no-option’ CLTI patients, presenting economic challenges to payers and providers alike. Calibrating the ICD codes will help to further elucidate these rates in ‘no option’ patients.