Trends of Non-Traumatic Lower-Extremity Amputation and Type 2 Diabetes: Spain, 2001–2019

Abstract

(1) Background: To examine trends in the incidence (2001–2019), clinical characteristics and in-hospital outcomes following major and minor non-traumatic lower-extremity amputations (LEAs) among people with type 2 diabetes mellitus (T2DM) in Spain, assessing possible sex differences. (2) Methods: Retrospective cohort study using data from the Spanish National Hospital Discharge Database. Joinpoint regression was used to estimate incidence trends, and multivariable logistic regression to estimate factors associated with in-hospital mortality (IHM). (3) Results: LEA was coded in 129,059 patients with T2DM (27.16% in women). Minor LEAs accounted for 59.72% of amputations, and major LEAs comprised 40.28%. The adjusted incidences of minor and major LEAs were higher in men than in women (IRR 3.51; 95%CI 3.46–3.57 and IRR 1.98; 95%CI 1.94–2.01, respectively). In women, joinpoint regression showed that age-adjusted incidence of minor LEAs remained stable over time, and for major LEAs, it decreased from 2006 to 2019. In men, incidences of minor and major LEAs decreased significantly from 2004 to 2019. In-hospital mortality (IHM) increased with age and the presence of comorbidity, such as heart failure (OR 5.11; 95%CI 4.61–5.68, for minor LEAs and OR 2.91; 95%CI 2.71–3.13 for major LEAs). Being a woman was associated with higher IHM after minor and major LEA (OR 1.3; 95%CI 1.17–1.44 and OR 1.18; 95%CI 1.11–1.26, respectively). (4) Conclusions: Our data showed major sex differences indicating decreasing and increasing LEA trends among men and women, respectively; furthermore, women presented significantly higher IHM after minor and major LEA procedures than men.

Temporal trends in patients with peripheral artery disease influenced by diabetes mellitus in Germany

“…An assessment on the Spanish National Hospital Discharge Database within the time frame 2001–2019 revealed decreasing incidences of lower extremity amputations in patients with T2DM. Remarkably, female sex was associated with higher in‐hospital mortality after amputations in this study 39 . A further investigation of the same study group on long‐term mortality of patients with T2DM after amputation demonstrated higher mortality after lower extremity amputation, whereas male sex was associated with an even higher risk 40 .…”

“…Remarkably, female sex was associated with higher in‐hospital mortality after amputations in this study. 39 A further investigation of the same study group on long‐term mortality of patients with T2DM after amputation demonstrated higher mortality after lower extremity amputation, whereas male sex was associated with an even higher risk. 40 Decreasing amputation rates in context to DM were also observed in Belgium.…”

Demographics and Etiology for Lower Extremity Amputations—Experiences of an University Orthopaedic Center in Germany

“…Most patients needing LEA in our population were males. Various studies have demonstrated that male sex is a risk factor for amputation, in the diabetic as well as in the non-diabetic population [ 4 , 9 , 11 , 14 , 16 , 17 , 18 , 19 ]. Additionally, males are significantly younger at the time of amputation compared to females as shown in the current study and other population-based studies [ 4 , 8 , 19 , 20 ].…”

“…Because of LEA’s high socioeconomic impact as well as the relevant effect on the amputees themselves, efforts have been made to analyze and reduce amputation rates. Population-based data show a trend towards declining rates for major amputations in Europe and worldwide in the last decades, but increasing rates for minor amputations at the same time [ 2 , 3 , 4 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. Generally, major amputations are defined as amputations proximal to, or through the ankle joint, whereas minor amputations are amputations distal to the ankle joint.…”

A review on contemporary nanomaterial-based therapeutics for the treatment of diabetic foot ulcers (DFUs) with special reference to the Indian scenario

“…The percentage mortality ranges from 15–42% in 2 years, 34–64% in 4 years and 40–80% in 6 years. 39 Among the DFU patients, the majority of foot ulcers are neuropathic, 18.7% ischemic, and 34.2% neuroischemic. Approximately 3% of DFU patients result in amputations.…”