A Canadian population-based description of the indications for lower-extremity amputations and outcomes

Kayssi, Ahmed; Mestral, Charles de; Forbes, Thomas L.; Roche-Nagle, Graham

doi:10.1503/cjs.013115

Cited by 53 publications

(56 citation statements)

References 22 publications

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“…Schofield et al concluded that diabetic amputees have a greater risk of heart failure (OR: 2.26; 95% CI 1.12–4.57) further amputation and death than nondiabetic amputees [12] and highlighted the need for a more aggressive approach in the management of cardiovascular risk factors in those who undergo amputation and have diabetes. A recent study in the Canadian population reported that predictors of prolonged hospital stay included cardiovascular risk factors, such as diabetes, hypertension, ischemic heart disease, congestive heart failure or hyperlipidemia [42]. …”

Section: Discussionmentioning

confidence: 99%

Predictors of in-hospital mortality following major lower extremity amputations in type 2 diabetic patients using artificial neural networks

López‐de‐Andrés

Hernández‐Barrera

López³

et al. 2016

BMC Med Res Methodol

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BackgroundOutcome prediction is important in the clinical decision-making process. Artificial neural networks (ANN) have been used to predict the risk of post-operative events, including survival, and are increasingly being used in complex medical decision making. We aimed to use ANN analysis to estimate predictive factors of in-hospital mortality (IHM) in patients with type 2 diabetes (T2DM) after major lower extremity amputation (LEA) in Spain.MethodsWe design a retrospective, observational study using ANN models. We used the Spanish National Hospital Discharge Database to select all hospital admissions of major LEA procedure in T2DM patients. Main outcome measures: Predictors of IHM using 4 ANN models: i) with all discharge diagnosis included in the database; ii) with all discharge diagnosis included in the database, excluding infectious diseases; iii) comorbidities included in the Charlson Comorbidities Index; iv) comorbidities included in the Elixhauser Comorbidity Index.ResultsFrom 2003 to 2013, 40,857 major LEAs in patients with T2DM were identified with a 10.0% IHM. We found that Elixhauser Comorbidity Index model performed better in terms of sensitivity, specificity and precision than Charlson Comorbidity Index model (0.7634 vs 0.7444; 0.9602 vs 0.9121; 0.9511 vs 0.888, respectively). The area under the ROC curve for Elixhauser comorbidity model was 91.7% (95% CI 90.3–93.0) and for Charlson comorbidity model was 88.9% (95% CI; 87.590.2) p = 0.043. Models including all discharge diagnosis with and without infectious diseases showed worse results. In the Elixhauser Comorbidity Index model the most sensitive parameter was age (variable sensitive ratio [VSR] 1.451) followed by female sex (VSR 1.433), congestive heart failure (VSR 1.341), renal failure (VSR 1.274) and chronic pulmonary disease (VSR 1.266).ConclusionsElixhauser Comorbidity Index is a superior comorbidity risk-adjustment model for major LEA survival prediction in patients with T2DM than Charlson Comorbidity Index model using ANN models. Female sex, congestive heart failure, and renal failure are strong predictors of mortality in these patients.

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Section: Discussionmentioning

confidence: 99%

Predictors of in-hospital mortality following major lower extremity amputations in type 2 diabetic patients using artificial neural networks

López‐de‐Andrés

Hernández‐Barrera

López³

et al. 2016

BMC Med Res Methodol

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“…Age-unadjusted rates are not ideal because they do not allow comparison with the rates from other countries or rates across different years that have different age compositions. 13,14 Recently, Kayssi et al 15 reported on LLAs in Canada from 2006 to…”

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confidence: 99%

Incidence of lower limb amputation in Canada

Imam

Miller

Finlayson

et al. 2017

Can J Public Health

136

108

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OBJECTIVES: To determine the Canadian age-adjusted incidence rates of lower limb amputation (LLA) by province, sex, level, and cause of amputation.METHODS: Data on all hospital discharges associated with LLA from April 1, 2006, to March 31, 2012, were obtained from the Canadian Institute for Health Information's Discharge Abstract Database. National and provincial age-adjusted rates were calculated per 100 000 individuals by sex, level, and cause of LLA using the direct method of standardization. The relative risk of LLA in people with diabetes was calculated.RESULTS: There were a total of 44 430 LLAs performed in Canada over the study years. The number of LLAs increased from 7331 in 2006 to 7708 in 2011. Mean (SD) age was 65.7 (16.6) years, and 68.8% were males. Sixty-five percent of the LLA cases were due to diabetes. The average age-adjusted rate of LLA in Canada was 22.9 per 100 000 individuals. The age-adjusted rates declined over the study years. The relative risk of diabetes-related LLAs was 28.9.CONCLUSION: This study provided the first Canadian national and provincial age-adjusted incidence rates of LLA and a baseline for monitoring and evaluation in the future. Understanding the incidence of LLA is essential to managing preventive and rehabilitation services for this population. Although the age-adjusted LLA incidence rates have decreased, the number of new LLAs has increased. The increase in the number of LLAs has important implications for social and health care costs.KEY WORDS: Incidence; epidemiology; amputation; diabetes; Canada La traduction du résumé se trouve à la fin de l'article.

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“…Vascular surgery persons with amputations, who generally have advanced peripheral arterial disease that necessitates a longer postoperative length of stay in hospital, may require less time at an inpatient rehabilitation facility secondary to initiation of rehabilitation before discharge from hospital. Indeed, we have reported previously that vascular surgery persons with amputations have a longer acute inpatient hospital stay compared with other persons with amputations [3,18]. Unfortunately, we are unable to further explain this postamputation rehabilitation trend with the current dataset.…”

Section: Discussionmentioning

confidence: 56%

“…Although great strides have been made in the medical treatment of the cardiovascular risk factors for amputation, almost 1 in 190 Americans currently is living with the loss of a limb, and that number may double by 2050 [2]. The overall incidence and prevalence of lower extremity amputations is not known, but we have previously shown that 81% of nontraumatic amputations in Canada were carried out as the result of diabetic complications [3].…”

Section: Introductionmentioning

confidence: 99%