Diabetes-related lower extremity amputations in Singapore

Abstract

Background: Lower extremity amputation (LEA) is defined as the complete loss in the transverse anatomical plane of any part of the lower limb. The objective of this study is to look at the trend and mortality trend of LEA performed in diabetes patients from 2008 to 2013. Methods: All patients age 15 and above with diabetes mellitus who had undergone LEAs (both major and minor) in Tan Tock Seng Hospital, Singapore from 1 January 2008 to 31 December 2013 were included. The outcomes of interest were deaths from all causes within 30 days and within 1 year. Results: Major LEA rate has increased from 11.0 per 100,000 population in 2008 to 13.3 per 100,000 population in 2013. The 30-day mortality rate ranges from 6.0% to 11.1% and the 1-year mortality rate ranges from 24.3% to 30.6%. Minor LEA rate has increased from 10.8 per 100,000 population in 2008 to 13.9 per 100,000 population in 2013. The 30-day mortality rate ranges from 1.5% to 3.7% and the 1-year mortality rate ranges from 9.7% to 18.3%. Conclusions: The trends in major and minor LEA are increasing. The 30-day and 1-year mortality for both major and minor LEA are comparable to figures reported worldwide. There is a need to re-look at preventive strategies to reduce LEA in diabetes patients in Singapore.

Incidence of chronic wounds in Singapore, a multiethnic Asian country, between 2000 and 2017: a retrospective cohort study using a nationwide claims database

“…22 At the same time, our results are consistent with the higher incidence of lower extremity amputations, a late complication of arterial and diabetic wounds, among Malays and Indians in Singapore. 23 More research is needed to determine the extent to which disparities are mediated by differences in the control of known risk factors, socioeconomic status and access to health services, so as to inform interventions that will aggressively mitigate these factors.…”

“…Arterial insufficiency ulcers: ICD-9-AM: 44023, 44024; ICD-10-AM: I70. 23 Pressure ulcers: ICD-9-AM: 7070; ICD-10-AM: L89.0, L89. 1, L89.2, L89.3, L89.4, L89.5, L89.6, L89.7, L89.8, L89.9.…”

Struggling for normality: experiences of patients with diabetic lower extremity amputations and post-amputation wounds in primary care

“…Lower extremity amputation is defined as the complete loss in the transverse anatomical plane of any part of the lower limb and can be divided into major (above ankle, through knee, and up to hip amputations) and minor (foot and toes) amputations (Nather and Wong, 2013;Ang et al, 2017;Chan et al, 2019). Diabetic lower extremity amputation (DLEA) is a major surgical procedure performed in patients with diabetes and generally disruptive to patients' normal life and can have a profound and lasting impact on an individual's physical and functional capacity and quality of life (Liu et al, 2010;Holzer et al, 2014;Barg et al, 2017;Silva et al, 2019).…”

Postoperative Death After Lower-Limb Amputation in a National Prevalent Cohort of Patients With Diabetes

“…Evidence shows that patients with diabetes who undergo lower-limb amputation have a high mortality rate (10)(11)(12)(13)(14)(15)(16). However, most investigations since have either focused on comparing rates between diabetic and nondiabetic populations (10,12,13,(17)(18)(19), only investigated long-term outcomes (12,20), or restricted analyses to subgroups of the diabetic population (20) or to single hospitals (21). A paucity of large studies have investigated mortality immediately after amputation in a well-defined diabetic population, and as such, gaps exist in our understanding of the frequency of postoperative mortality in this population, how postoperative mortality differs within this population, and the factors that ultimately drive this outcome.…”