Major Amputation Incidence Decreases Both in Non-Diabetic and in Diabetic Patients in Helsinki

Eskelinen, E; Eskelinen, Antti; Albäck, Anders; Lepäntalo, Mauri

doi:10.1177/145749690609500311

Cited by 53 publications

(40 citation statements)

References 28 publications

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“…Similar observations have been made in otherl arge diabetic population studies as well (14,15). The results from Southern Finland aretowards the same direction, both in diabetics and non-diabetics, but not as good as than in Denmark (16). This may reflect the morer ecent time period of data collection or the need to improve the treatment chain of problem wounds.…”

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confidence: 82%

Invited Commentary

Lepäntalo

2008

Scand J Surg

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supporting

confidence: 82%

Invited Commentary

Lepäntalo

2008

Scand J Surg

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“…A Finnish study is based only on retrospective clinical records of 1094 patients undergoing major lower limb amputations for vascular disease in the town of Helsinki during the 13 years from 1990 to 2002. 4 A German study analyzed medical records of 692 patients who had received non-traumatic lower-limb amputations in 1990-1991 and 1994-2005 and calculated incidence rates for the estimated German diabetic population. 8 These incidence rates in the diabetic population per 100,000 personyears varied considerably between years (maximum 549 in 1990, minimum 281 in 2004).…”

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confidence: 99%

Amputations in PAD patients: Data from the German Federal Statistical Office

et al. 2009

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Much effort has been spent to reduce the number of amputees within the last two decades, but it remains unclear how effective the different strategies have been. We analyzed the prevalence of amputations in inpatient cases in the federal statistics. Detailed lists of all amputations coded as major amputations Based on these data age-adjusted incidence rates of major amputations per 100,000 inhabitants increased from 2 at the age of < 50 years to 201 at the age of > 80 years. For minor amputations the prevalence rates increased from 4 at the age of < 50 years to 209 at the age of > 80 years. It can be assumed that peripheral arterial disease or neurovascular disease as the underlying disease necessitating the amputation were present in 74.9% of all inpatient cases who finally underwent amputation. There were 12.9% with non-vascular or non-diabetic reasons for amputations. In patients presenting with gangrene, the rate of minor amputations decreased with age, whereas the rate of major amputations increased, especially within the 8th to 10th decades of life. In conclusion, amputations affecting the lower limbs are still a relevant problem in Germany. At the time of an aging German population it has to be an important goal to lower or at least to stabilize the rate of amputations. The DRG statistics enable the Federal Ministry of Health and health politics to monitor amputation rates easily.

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“…In recent years, decreasing incidence rates of amputations were reported from several areas in the U.S., Finland, the Netherlands, and Italy (3,(5)(6)(7)(8)(9)(10). By contrast, no data showing a reduction of amputations since 1989 in any part of Germany have been published to date (3,11,12).…”

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confidence: 94%

Reduced Incidence of Lower-Limb Amputations in the Diabetic Population of a German City, 1990–2005

et al. 2007

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OBJECTIVE -We evaluated whether the incidence of amputations in one German city (Leverkusen, population ϳ160,000) had decreased between 1990 and 2005. RESEARCH DESIGN AND METHODS-From all three hospitals in the city, we obtained complete lists of nontraumatic lower-limb amputations in 1990 -1991 and 1994 -2005. Only the first observed amputation in residents of Leverkusen was counted. A total of 692 patients met the inclusion criteria. Data about the population stucture, separately for each year of the observation period, were received from the city administration and the Federal Office of Statistics. To test for time trend, we fitted Poisson regression models.RESULTS -Of all subjects, 72% had known diabetes and 58% were male. Mean age was 71.7 years. Incidence rates in the diabetic population (standardized to the estimated German diabetic population per 100,000 person-years) varied considerably between years (maximum 549 in 1990, minimum 281 in 2004). In the diabetic population, the estimated relative risk (RR) per year was 0.976 (95% CI 0.958 -0.996, P ϭ 0.0164). The same trend was observed when only amputations above the ankle (n ϭ 352) , P ϭ 0.0318) were considered. Over 15 years, an estimated reduction of amputations above the toe level by 37.1% (95% CI 12.3-54.8) results. There was no significant change of incident amputations in the nondiabetic population (RR 1.022 [0.989 -1.056], P ϭ 0.1981).CONCLUSIONS -This finding is likely to be due to improved management of the diabetic foot syndrome after a network of specialized physicians and defined clinical pathways for wound treatment and metabolic control were introduced. Diabetes Care 30:2633-2637, 2007I n 1989, a reduction of the number of amputations in the diabetic population by at least one-half within 5 years was declared a primary objective for Europe (St. Vincent Declaration) (1). We published baseline data about the incidence rates of amputations in the city of Leverkusen, Germany, in 1990 and 1991, as well as follow-up data through 1998 (2,3). We found that the risk of having an amputation was 26-fold (95% CI 17-39) in the diabetic population compared with that in the nondiabetic population. Moreover, 96% (94 -97) of the amputation risk in diabetic individuals and 70% (61-77) of the amputation risk in the entire population were due to diabetes (2,3). We estimated that ϳ31,000 patients in Germany underwent first amputations per year, that 23,000 of these patients had diabetes, and that 21,000 had their amputations due to their diabetes (4). No change in incidence rates over time could be detected between 1990 and 1998 (3). In the present study, we continued the collection of these data from 1999 through 2005 and combined them with the existing dataset to ascertain a potential change in incidence rates.The incidence of amputations in diabetic individuals dropped significantly in several areas in various countries and populations, such as Alaska Natives, American Indians, Denmark, and Sweden, after various specific programs for foot care and prevention...

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Major Amputation Incidence Decreases Both in Non-Diabetic and in Diabetic Patients in Helsinki

Cited by 53 publications

References 28 publications

Invited Commentary

Invited Commentary

Amputations in PAD patients: Data from the German Federal Statistical Office

Reduced Incidence of Lower-Limb Amputations in the Diabetic Population of a German City, 1990–2005

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