Lower limb amputation in Northern Netherlands

Abstract

Background: Investigating population changes gives insight into effectiveness and need for prevention and rehabilitation services. Incidence rates of amputation are highly varied, making it difficult to meaningfully compare rates between studies and regions or to compare changes over time. Study Design: Historical cohort study of transtibial amputation, knee disarticulation, and transfemoral amputations resulting from vascular disease or infection, with/without diabetes, in [2003][2004], in the three Northern provinces of the Netherlands. Objectives: To report the incidence of first transtibial amputation, knee disarticulation, or transfemoral amputation in [2003][2004] and the characteristics of this population, and to compare these outcomes to an earlier reported cohort from 1991 to 1992. Methods: Population-based incidence rates were calculated per 100,000 person-years and compared across the two cohorts. Results: Incidence of amputation was 8.8 (all age groups) and 23.6 (≥45 years) per 100,000 person-years. This was unchanged from the earlier study of 1991-1992. The relative risk of amputation was 12 times greater for people with diabetes than for people without diabetes. Conclusions: Investigation is needed into reasons for the unchanged incidence with respect to the provision of services from a range of disciplines, including vascular surgery, diabetes care, and multidisciplinary foot clinics. Clinical relevanceThis study shows an unchanged incidence of amputation over time and a high risk of amputation related to diabetes. Given the increased prevalence of diabetes and population aging, both of which present an increase in the population at risk of amputation, finding methods for reducing the rate of amputation is of importance.

Reduction of residual limb volume in people with transtibial amputation

“…The mortality rate of people with TTA with vascular disease, with or without diabetes or with infection, in the northern Netherlands was 44 percent in 2003 to 2004 [26]. In accordance with an earlier study, fewer people with amputation who went to a rehabilitation center died in the first year after amputation than people with amputation who went to a skilled nursing facility after their initial hospital stay [1].…”

Incidence of lower limb amputation in Canada

“…Netherlands (8.8 per 100 000 in 2004), 4 and smaller than that of others (92.5 per 100 000 in 2009), such as Ireland. 5 The observed downturn in the age-adjusted LLA incidence rates is consistent with the recent literature.…”

“…The main reason for LLA in Western countries is attributed to the complications associated with diabetes. 2 The incidence of LLA varies widely throughout the world, 3 ranging from 8.8 per 100 000 in the Netherlands in 2004 4 to 92.5…”

Outcomes of dysvascular partial foot amputation and how these compare to transtibial amputation: a systematic review for the development of shared decision-making resources

“…Helping people make well-informed decisions about PFA has become increasingly important given the shift in types of lower limb amputation performed [3–7]. The incidence of transtibial amputation (TTA) has declined steadily since about the year 2000 [3, 8–11], and there is some evidence that PFA has increased proportionately [3, 6, 10].…”