A 20-Year Analysis of Trends in the Incidence and In-Hospital Mortality for Lower Extremity Arterial Thromboembolism
Background—Epidemiology data for lower extremity arterial thromboembolism (LET) is limited and may result from either acute limb ischemia (ALI) or an acute exacerbation of critical limb ischemia (CLI). Given marked changes in both diagnosis and therapy over the last two decades, we hypothesized that this time period would have witnessed reductions in both incidence and in-hospital mortality of LET.
Methods and Results—Data from 1988 through 2007 from National Hospital Discharge Survey were analyzed. All admissions with LET were extracted, and the respective ICD-9-CM codes were internally validated for both LET and ALI. Descriptive statistics were employed. The validity of the ICD-9-CM codes in identifying LET cases was good but poor for identifying ALI cases as many of these acute presentations were due to CLI. Over the twenty-year span, there were 1.76 million cases of LET. The incidence of LET significantly decreased from 42.4/100,000 persons between 1988-1997 to 23.3/100,000 persons between 1998-2007. The in-hospital mortality for LET significantly decreased from 8.28% between 1988-1997 to 6.34% between 1998-2007, and males achieved greater mortality reduction compared to females. Treatments for ALI showed decreasing utilization of surgical bypass and amputation and increasing rates of catheter-based thrombolysis.
Conclusions—Over the twenty-year study period, there have been significant reductions in both LET incidence and in-hospital mortality. Unfortunately, LET admissions extracted from an administrative database comprise a diverse group of individuals, including those with acute and chronic forms of limb ischemia as well as iatrogenic arterial injury, limiting the true assessment of ALI incidence.
- Received May 2, 2013.
- Accepted May 10, 2013.