Trends of limb amputation considering type, level, sex and age in Saskatchewan, Canada 2006–2019: an in-depth assessment

Abstract

Background Most epidemiologic reports focus on lower extremity amputation (LEA) caused specifically by diabetes mellitus. However, narrowing scope disregards the impact of other causes and types of limb amputation (LA) diminishing the true incidence and societal burden. We explored the rates of LEA and upper extremity amputation (UEA) by level of amputation, sex and age over 14 years in Saskatchewan, Canada. Methods We calculated the differential impact of amputation type (LEA or UEA) and level (major or minor) of LA using retrospective linked hospital discharge data and demographic characteristics of all LA performed in Saskatchewan and resident population between 2006 and 2019. Rates were calculated from total yearly cases per yearly Saskatchewan resident population. Joinpoint regression was employed to quantify annual percentage change (APC) and average annual percent change (AAPC). Negative binomial regression was performed to determine if LA rates differed over time based on sex and age. Results Incidence of LEA (31.86 ± 2.85 per 100,000) predominated over UEA (5.84 ± 0.49 per 100,000) over the 14-year study period. The overall LEA rate did not change over the study period (AAPC -0.5 [95% CI − 3.8 to 3.0]) but fluctuations were identified. From 2008 to 2017 LEA rates increased (APC 3.15 [95% CI 1.1 to 5.2]) countered by two statistically insignificant periods of decline (2006–2008 and 2017–2019). From 2006 to 2019 the rate of minor LEA steadily increased (AAPC 3.9 [95% CI 2.4 to 5.4]) while major LEA decreased (AAPC -0.6 [95% CI − 2.1 to 5.4]). Fluctuations in the overall LEA rate nearly corresponded with fluctuations in major LEA with one period of rising rates from 2010 to 2017 (APC 4.2 [95% CI 0.9 to 7.6]) countered by two periods of decline 2006–2010 (APC -11.14 [95% CI − 16.4 to − 5.6]) and 2017–2019 (APC -19.49 [95% CI − 33.5 to − 2.5]). Overall UEA and minor UEA rates remained stable from 2006 to 2019 with too few major UEA performed for in-depth analysis. Males were twice as likely to undergo LA than females (RR = 2.2 [95% CI 1.99–2.51]) with no change in rate over the study period. Persons aged 50–74 years and 75+ years were respectively 5.9 (RR = 5.92 [95% Cl 5.39–6.51]) and 10.6 (RR = 10.58 [95% Cl 9.26–12.08]) times more likely to undergo LA than those aged 0–49 years. LA rate increased with increasing age over the study period. Conclusion The rise in the rate of minor LEA with simultaneous decline in the rate of major LEA concomitant with the rise in age of patients experiencing LA may reflect a paradigm shift in the management of diseases that lead to LEA. Further, this shift may alter demand for orthotic versus prosthetic intervention. A more granular look into the data is warranted to determine if performing minor LA diminishes the need for major LA.

Fact Sheet of Amputee 10-Year Trends in Korea: From 2011 to 2020

“…In this study, the prevalence of upper-extremity amputation was higher than that of lower-extremity amputation compared to previous studies [ 5 ], but the results were similar to those of other studies, except for amputation under the wrist [ 5 ]. It is supposed that there were many wrist amputations due to trauma, and that they had a longer lifespan than other amputees, which may have affected the prevalence.…”

“…The United States reports 185,000 amputations each year, from 1.6 million in 2005 to be 3.6 million by 2050 [4]. In Saskatchewan, Canada, the incidence of amputation per 100,000 was reported to be 31.86 in the lower exwww.e-arm.org tremities and 5.84 in the upper extremities [5]. It was also noted that the number of minor lower limb amputations, such as those below the ankle amputation, increased, while the number of major amputations decreased [5].…”

“…In Saskatchewan, Canada, the incidence of amputation per 100,000 was reported to be 31.86 in the lower exwww.e-arm.org tremities and 5.84 in the upper extremities [5]. It was also noted that the number of minor lower limb amputations, such as those below the ankle amputation, increased, while the number of major amputations decreased [5]. In South Korea, 38.3 amputations occurred per 100,000 people, and finger amputation accounted for 93.7%, being the highest, according to Korean workers' compensation insurance data in 2019 [6].…”

Comorbidity and risk factors of subsequent lower extremity amputation in patients diagnosed with diabetes in Saskatchewan, Canada

“…16 The SK-DAD accommodates up to 25 diagnoses defined by the Canadian adaptation of the International Classification of Diseases codes (ICD-10-CA) and 20 interventions defined by the Canadian Classification of Health Intervention codes (CCI) per hospitalization. 1 The SK-DAD is similar to the national discharge data collated by the Diagnosis-Related Group Statistics (DRG-Statistics) in Germany, 17 which captures Germany's all acute care hospital inpatient cases, diagnoses defined by the German adaptation of the International Classification of Diseases (ICD-10-GM), German intervention procedure codes (OPS), demographic information and discharge status. 17 Furthermore, the SK-DAD is also comparable to the Swedish National Inpatient Register (INP) comprises the Hospital Discharge Register 18,19 and links several national Swedish registers via a unique Swedish personal identifier number.…”

“…The overall rate of limb amputation has remained stable over two decades in Saskatchewan despite increasing community efforts to educate and manage people with diabetes, the leading cause of lower extremity amputation. 1 Subsequent limb amputation (SLA), defined as ipsilateral revision amputation or contralateral index (single) amputation, may be performed to mitigate disease progression, reduce pain and enhance prosthesis fit. [2][3][4] A recent meta-analysis by Liu et al (2021) found SLA rates of 19% at 1 year and 37.1% at 5 years in people with diabetes.…”