Declines in Lower Extremity Amputation in the US Medicare Population, 2000-2010

Belatti, Daniel A.; Phisitkul, Phinit

doi:10.1177/1071100713475357

Cited by 39 publications

(27 citation statements)

References 25 publications

(33 reference statements)

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“…Over 8% of the population has diabetes, disproportionally leading to nearly two thirds of all non-traumatic amputations (nearly 66,000 in 2006) (CDCP, 2011). Recently, there has been a trend of reduced non-traumatic amputation rates, both in veterans (Tseng et al, 2011) and the general population (Belatti and Phisitkul, 2013; Li et al, 2012), likely a result of improved preventative care, increase revascular interventions, and evolving orthopaedic management (Belatti and Phisitkul, 2013). However, in terms of the shear number of amputations per year (Belatti and Phisitkul, 2013; Tseng et al, 2011), and by the fact diabetic subjects undergo a disproportionate percentage of all amputations (CDCP, 2011; Li et al, 2012), diabetic foot ulceration remains an issue that requires further study.…”

Section: Introductionmentioning

confidence: 99%

The association between mechanical and biochemical/histological characteristics in diabetic and non-diabetic plantar soft tissue

Ledoux

Pai

Shofer³

et al. 2016

Journal of Biomechanics

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Diabetes, and the subsequent complication of lower limb ulcers leading to potential amputation, remains an important health care problem in United States, even with declining amputation rates. It has been well documented that diabetes can alter the mechanical properties (i.e., increased stiffness) of the plantar soft tissue, although this finding is not universal. Similarly, biochemical and histological changes have been found in the plantar soft tissue, but, as with the mechanical changes, these findings are not consistent across all studies. Our group’s work has demonstrated that diabetes increases plantar soft tissue modulus and increases elastic septal thickness. The purpose of the current study was to explore the association between mechanical, biochemical and histological properties. Using previously collected data, a linear mixed effects regression was conducted. The correlations were weak; of the 32 that were tested, only 3 (modulus to septal thickness when location was accounted for, energy loss to total collagen, and energy loss to collagen/elastin ratio) were statistically significant, none with an R2 greater than 0.10. The main differences in the means were increase tissue stiffness and increase septal wall thickness, both trends were supported in the literature. However, as the correlations were weak, it is likely that another unexamined biochemical factor (perhaps collagen crosslinking) is associated with the mechanical tissue changes.

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Section: Introductionmentioning

confidence: 99%

The association between mechanical and biochemical/histological characteristics in diabetic and non-diabetic plantar soft tissue

Ledoux

Pai

Shofer³

et al. 2016

Journal of Biomechanics

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“…5 The observed downturn in the age-adjusted LLA incidence rates is consistent with the recent literature. [6][7][8] In the US, the rates were reported to have declined from 2000 to 2010. 6 It is difficult to meaningfully compare the rates across countries because different methods have been employed for reporting the incidence rates.…”

Section: Lower Limb Amputation In Canadamentioning

confidence: 99%

“…5 Unlike earlier studies that have shown an increase in the incidence of LLA in Western countries, 6 the most recent studies have reported a decline or no change in the rates. [7][8][9] The LLA incidence data are unknown for Canada. As a result, incidence rates from other countries, particularly the United States, are commonly used to support health care planning and research initiatives.…”

mentioning

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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“…1 The number of patients with DPN has increased in recent years while the numbers of patients with ulcers, peripheral arterial disease, and lower extremity amputation have decreased. 2,3 Although the reason for improvements isn't known, it' s likely to be a combination of better preventive foot care, intensive blood glucose management, and improved therapies for foot ulcers.…”

Section: Understanding Dpnmentioning

confidence: 99%