Clinical ResearchBurden of Infected Diabetic Foot Ulcers on Hospital Admissions and Costs
Introduction
The prevalence of diabetes mellitus is increasing annually across the United States. The number of hospital discharges associated with diabetes has increased from 4.6 million in 2001 to 5.5 million in 2009.1 As a result, costs associated with diabetes care are also rising. In 2012, the direct medical costs associated with diabetes were $176 billion, which is 2.3 times higher than healthcare costs associated with care of nondiabetic patients.2
Approximately 33% of diabetes-related costs have been linked to the treatment of foot ulcers,3 the majority of which are related to inpatient hospital admissions.4 Hospital inpatient care accounts for at least 50% of the national diabetes cost burden overall,5 and hospital charges and costs related to diabetic foot ulcers specifically have increased significantly over the past 5 years.6 Interestingly, hospital admissions for diabetic foot ulcers were relatively stable between 2003 and 2007, ranging from 112,000 to 115,000 admissions per year.7 In addition, the rate of lower extremity amputation among patients with diabetes is stable or even decreasing; the estimated lower extremity amputation rate among diabetic patients was 3.1/10,000 admissions in 2001 compared with 2.2/10,000 admissions in 2009.8 Therefore it is currently unclear why hospital costs associated with diabetic foot ulcer care is increasing.
In this study, we sought to describe the impact of diabetes on foot ulcer admissions in the United States, including the etiology, incidence of major and minor lower extremity amputations, and to investigate potential explanations for rising hospital costs among patients with foot ulcers and diabetes compared with those with foot ulcers and no diabetes.
Section snippets
Study Design
Data were obtained from the Healthcare Cost and Utilization Project's (HCUP) Nationwide Inpatient Sample (NIS). We performed a retrospective analysis of all patients aged 18 to 99 years, admitted with a primary diagnosis of foot ulceration (ICD-9 codes 440.23, 707.14–707.15) between January 1, 2005 and December 31, 2010. Patients admitted for trauma, acute limb ischemia, compartment syndrome, fasciotomy, pressure ulcers, venous hypertension, or gestational diabetes, as well as those with
Temporal Trends in Foot Ulcer Admissions Over Time
There were 962,496 foot ulcer admissions over the 6-year study period. Of these, 91.8% (n = 883,463) of admissions were among patients with diabetes, compared with 8.2% (n = 79,033) admissions among patients with no diabetes. The number of foot ulcer admissions in 2005 was 150,418 (95% confidence interval [CI] 148,755–152,082). The number of foot ulcer admissions increased to 165,277 (95% CI 163,537–167,016) in 2006 (P < 0.001), after which there were no significant variations in the number of
Discussion
The prevalence of diabetes and diabetes-related morbidity is rising. Based on data from the Centers for Disease Control (CDC), the US population in 2010 was 308,745,538.11 Assuming a diabetes prevalence of 8.3%,12 approximately 25,625,880 Americans are currently affected by diabetes. Similarly, hospital costs are rising.6, 13, 14 Specifically, diabetic foot ulcer care costs the Medicare system approximately $1.5 billion per year,4 ranging anywhere from $3,000 to $108,000 per ulcer depending on
References (27)
- et al.
The costs of diabetic foot: the economic case for the limb salvage team
J Vasc Surg
(2010) - et al.
A diabetic foot service established by a department of vascular surgery: an observational study
Ann Vasc Surg
(2012) Diabetic revascularization: endovascular versus open bypass—do we have the answer?
Semin Vasc Surg
(2012)Number (in Thousands) of Hospital Discharges with Diabetes as Any-Listed Diagnosis, United States, 1988–2009
(2009)National Diabetes Statistic Report, 2014
(2014)- et al.
A cost analysis of diabetic lower-extremity ulcers
Diabetes Care
(2000) Economic costs of diabetes in the U.S. In 2007
Diabetes Care
(2008)- et al.
Trends and determinants of costs associated with the inpatient care of diabetic foot ulcers
J Vasc Surg
(2014) Number (in Thousands) of Hospital Discharges with Peripheral Arterial Disease (PAD), Ulcer/Inflammation/Infection (ULCER), or Neuropathy as First-Listed Diagnosis and Diabetes as Any-Listed Diagnosis United States, 1988–2007
(2014)Number (in Thousands) of Hospital Discharges for Nontraumatic Lower Extremity Amputation with Diabetes as a Listed Diagnosis, United States, 1988–2009
(2012)
ICDPIC: Stata Module to Provide Methods for Translating International Classification of Diseases (Ninth Revision) Diagnosis Codes into Standard Injury Categories and/or Scores
Consumer Price Index (CPI) Conversion Factors 1774 to Estimated 2022 to Convert to Dollars of 2010
NVSS—National Vital Statistics System
Cited by (178)
End of Life Care for Unplanned Vascular Admissions
2024, Annals of Vascular SurgeryThou shall not heal: Overcoming the non-healing behaviour of diabetic foot ulcers by engineering the inflammatory microenvironment
2023, Advanced Drug Delivery ReviewsAssessing the Utility of Toe Arm Index and Toe Pressure in Predicting Wound Healing in Patients Undergoing Vascular Intervention
2023, Annals of Vascular SurgeryRisk Factors for Hospital Re-admission for Diabetes Related Foot Disease: A Prospective Cohort Study
2023, European Journal of Vascular and Endovascular SurgeryEditor's Choice – A Systematic Review and Meta-Analysis of the Incidence and Risk Factors for Re-admission to Hospital in People with Diabetes Related Foot Disease
2023, European Journal of Vascular and Endovascular SurgeryPredictive Value of MRSA Nares Colonization in Diabetic Foot Infections: A Systematic Review and Bivariate Random Effects Meta-Analysis
2023, Journal of Foot and Ankle Surgery
Disclosures: No competing interests declared. This work was completed without financial support.