Estimating the Problem of Chronic Wounds
Baylor College of Medicine, Houston, Texas
Friday’s session on CLTI Wounds saw Caroline E. Fife, MD, from Baylor College of Medicine and Intellicure LLC, give a presentation entitled “We Are Underestimating the Problem of Chronic Wounds.” Her presentation underscored how gaps in diagnosis coding, classification disagreements, and underreporting distort both prevalence and cost estimates, leading to inadequate attention and funding.
While surgical and traumatic wounds have ICD-10 codes, many clinically recognized ulcers—such as diabetic foot ulcers (DFUs), venous leg ulcers (VLUs), arterial ulcers, and chronic “non-pressure” ulcers—lack coding. Even when wounds are identified, their etiology is often unclear or contested. For example, a heel ulcer in a diabetic patient with peripheral arterial disease might be diagnosed as a pressure injury, a diabetic foot ulcer, or an arterial ulcer depending on the clinician’s perspective. Without consistent definitions, counting and tracking these wounds is nearly impossible.
Wound centers manage an overwhelming range of conditions, including ulcers due to systemic diseases. All wounds are symptoms of an underlying disease, Dr Fife emphasized, and as the prevalence of these diseases rises, so too will the prevalence of chronic wounds.
The complexity deepens when patients present with multiple ulcers, Dr Fife told attendees. Data show DFU patients average 1.7 diabetic foot ulcers and 2.7 total ulcers, while VLU patients average 1.8 venous leg ulcers and 2.5 total ulcers. Overlap is common; 13% of DFU patients also have a VLU, and 17% of VLU patients also have a DFU. Among those with diabetes, 41.6% had a venous ulcer. Complicating matters further, multiple ulcers of the same type and location are often collapsed into one code, and new ulcers that develop during treatment may go uncounted.
Dr Fife presented additional data showing that the prevalence of chronic wounds among Medicare beneficiaries rose from 14.5% to 16.4% between 2014 and 2019, translating to an increase from 8.2 million to 10.5 million patients. The sharpest growth has been in adults under age 65 with disabilities. The estimated annual cost to Medicare is approximately $67 billion. Chronic wounds, she said, affect more patients and incur higher costs than heart failure or cancer, yet they receive far less public health attention and funding.
Dr. Fife’s presentation painted a clear picture: chronic wounds are both more common and more costly than most realize, yet they remain underrepresented in health policy discussions.
