10 years Analysis of Diabetes-related Major Lower Extremity Amputations in Mexico

Abstract

Background: Little is known about diabetes-related major lower extremity amputations (DMLEA) burden in México.

Aim of the study: To describe DMLEA hospitalization rates, in-hospital survival rates, characteristics associated with all-cause in-hospital mortality and direct costs of hospitalization during the 2005-2015 period, in the two principal Health Institutions in Mexico: the Mexican Institute of Social Security (IMSS) and the Ministry of Health (MoH).

Methods: A secondary data analysis was conducted using hospital discharge information obtained from administrative databases. Non-traumatic DMLEA hospitalizations in adults aged 20 years and over were analyzed. Hospitalization characteristics and in-hospital all-cause mortality risk were also assessed. Direct costs of hospitalization including length of hospital stay, surgical procedure, wound care and medical emergency consultation were accounted in U.S. dollars (USD, 2015).

Results: There were 34,051 DMLEA hospitalizations and 1,268 in-hospital deaths. DMLEA hospitalizations rates increase from 4.71-6.12 × 100,000 affiliates during 2005 and 2015 respectively for both institutions together. Females and age ≥60 years were associated with all-cause in-hospital death. The all-period direct costs of hospitalization amounted to $132.51 million USD ($86.30 in the IMSS and $46.21 in the MoH), and showed a sustained increment: from $4.14 million USD in 2005 to $24.84 million USD in 2015 (percentage increase 499.3%).

Conclusions: In-hospital mortality was 3.7%. Female sex and age ≥60 years were characteristics associated with all-cause in-hospital death. The increase in the number of DMLEA hospitalizations and their direct costs, reflects a negative progression of diabetes in the two largest Health Institutions in Mexico.

Keywords: Amputation; Diabetic complications; Hospital costs; Hospitalization; Lower extremity; Survival.