Amputation rates are increasing for both opioid-related and non-opioid-related hospitalizations in the US, with a steeper rise among opioid-related cases. From 2016 to 2022, crude amputation rates rose from 55.6 to 92.3 per 10,000 opioid-related hospitalizations and from 58.9 to 79.7 per 10,000 non-opioid-related hospitalizations.
Researchers from Massachusetts General Hospital in Boston, led by George Karandinos, M.D., Ph.D., analyzed the National Inpatient Sample to estimate national and regional changes in amputation rates among opioid-related hospitalizations.
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The study found that higher anatomical amputation levels were more common in opioid-related hospitalizations. According to the researchers, contamination of street opioids with xylazine, an α2-agonist with no approved human use, may be contributing to the increase in areas where it is especially prevalent, such as the Northeast.
National Trends
Nationally, crude amputation rates increased from 2016 to 2022 for both opioid-related and non-opioid-related hospitalizations. The researchers found that 41,010,691 hospitalizations of persons aged 18 years or older occurred during this period, with 3.0% of these being opioid-related.
A difference-in-differences analysis showed greater increases in amputation rates among opioid-related versus non-opioid-related hospitalizations at the national level, as well as in the Northeast and West census regions, and in the New England and Pacific census divisions.
Regional Variations
The study found that crude amputation rates increased across all census regions, with steeper apparent increases among opioid-related hospitalizations. In the Northeast, for example, the crude amputation rate increased by 18.4 per 10,000 opioid-related hospitalizations.
In the West census region, the crude amputation rate increased by 19.1 per 10,000 opioid-related hospitalizations. The researchers noted that these regional variations may be due to differences in the prevalence of xylazine contamination in street opioids.
The study’s findings were published in the Annals of Internal Medicine and can be found online with the DOI: 10.7326/annals-25-05273. The researchers hope that their study will raise awareness about the increasing amputation rates among opioid-related hospitalizations and the potential role of xylazine contamination in this trend.
On a typical day, the researchers spent around 8 hours reviewing data and analyzing the results. The study was conducted in room 304 of the Massachusetts General Hospital.
The researchers’ findings have implications for public health policy and clinical practice, particularly in regions with high rates of opioid-related hospitalizations. As the US continues to grapple with the opioid epidemic, studies like this one can inform efforts to address the root causes of this crisis and develop effective solutions to mitigate its effects.
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