Epidemiology of Major Lower Extremity Amputations in Individuals With Diabetes in Austria, 2014-2017: A Retrospective Analysis of Health Insurance Database

Abstract

Background: Previous data show a high incidence of major lower extremity amputations (LEA) in Austria. Moreover, recent data on the epidemiology of major LEA are sparse in the Country. This study estimated the incidence and mortality rates of major LEA and assessed risk factors of post major LEA mortality in individuals with diabetes.Methods: A retrospective cohort analysis of 507,180 individuals with diabetes enrolled in the Austrian Health Insurance between 2014 and 2017 was performed. Crude and age-standardized rates of major LEA (hip, femur, knee, lower leg) were estimated by extracting their procedure codes from the database. Short- (30-day, 90-day) and long-term (1-year, 5-year) all-cause cumulative mortality after major LEA was estimated from the date of amputation till the date of death. Poisson regression was performed to compare rates by characteristics and assess the annual trend. The Cox-regression was performed to identify significant risk factors of all-cause mortality after major LEA.Results: A total of 2,165 individuals with diabetes underwent major LEA between 2014 and 2017. The mean age was amputees was 73.0 ±11.3 years, 62.7% were males, and 87.3% had a peripheral vascular disease (PVD). The overall age-standardized rate was 6.44 per 100,000 population. The rate increased with age (p<0.001) and was higher (p<0.001) in males (9.38) than females (5.66). The rate was 5.71 in 2014, 6.86 in 2015, 6.71 in 2016, and 6.66 in 2017, with an insignificant annual change of 3% (p=0.825). The cumulative 30-day mortality was 13.5%, 90-day was 22.0%, 1-year was 34.4%, and 5-year was 66.7%. Age, male sex, above-knee amputation, Charlson index, and heart failure were significantly associated with both short- and long-term mortality. Cancer, dementia, heart failure, PVD, and renal disease were only associated with long-term mortality.Conclusions: The rate of major LEA remained stable between 2014 and 2017 in Austria. Short and long-term mortality rates were considerably high after major LEA. Old age, male sex, above-knee amputations, heart failure, and Charlson Index were significant predictors of both short- and long-term mortality, whereas, comorbidities such as cancer, dementia, PVD, and renal disease were significant predictors of long-term mortality only.

The Kenevo microprocessor-controlled prosthetic knee compared with non–microprocessor-controlled knees in individuals older than 65 years in Sweden: A cost-effectiveness and budget-impact analysis

“…In 2018, the Swedish Amputation and Prosthetics Registry for the Lower Extremity (SwedeAmp) reported more than 80% of amputations as being due to PVD and/or DM, an average age at amputation of 74 years and a 6-month mortality of 19%. 18 These numbers corroborate recent Austrian, 19 Danish, 20 and German 21 data and highlight the need for research to prioritize these elderly comorbid individuals. In Sweden, prescriptions of MPKs are rare among those older than 65 years as indicated by unpublished figures from SwedeAmp showing that approximately 1.5% were prescribed an MPK for the first ever prosthesis and 7% for a later prosthesis during the years 2016–2020.…”

Comparison of Charlson Comorbidity Index and Modified 5-Factor Frailty Index as Clinical Risk Stratification Tools in Predicting Adverse Outcomes in Patients Undergoing Lower Extremity Free-Flap Reconstruction

“…Multiple studies have demonstrated that CCI has predictive value in patients with LE pathology. 32 33 34 36 37 However, to date, there is no clear consensus on the most useful risk stratification method to predict postoperative adverse outcomes in elderly patients who are undergoing LE free-flap reconstruction. Therefore, the purpose of this study is to compare the utility of CCI and mFI-5 in predicting postoperative morbidity in comorbid elderly patients undergoing FTT reconstruction for lower limb salvage.…”

“…Multiple studies have demonstrated that CCI has predictive value in patients with LE pathology. [32][33][34]36,37 However, to date, there is no clear consensus on the most useful risk stratification method to predict postoperative adverse outcomes in elderly patients who are undergoing LE free-flap reconstruction.…”