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

Gutacker, Nils; Neumann, Anja; Santosa, Frans; Moysidis, Theodorus; Kröger, Knut

doi:10.1177/1358863x09346658

Cited by 20 publications

(17 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The findings align with international studies indicating that people undergoing amputations were more likely to be older (mean 62 years), male (by a ratio of 2:1) and have diabetes or peripheral arterial disease (approximately 80%) [1,4,5,9,13,14,16]. Also the major to minor amputation ratio (1.19:1) seems to be consistent with international literature [1,10,36].…”

Section: Discussionsupporting

confidence: 89%

“…In the UK and Europe diabetes accounts for around 40 - 64% of amputations [4,9,11,15]. Peripheral arterial disease is a contributing cause for between 16 – 100% of global amputations [1], and a primary cause (without diabetes or non-diabetes) for 18 – 58% of amputations in the UK and European countries [5,11,14,16]. Amputations related to trauma result in between 0 – 57% of all global amputations and trauma appears to be the primary cause of 2 – 13% of UK and European amputations [3,5].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

What are the key conditions associated with lower limb amputations in a major Australian teaching hospital?

Lazzarini

O'Rourke

Russell

et al. 2012

Journal of Foot and Ankle Research

View full text Add to dashboard Cite

BackgroundLower extremity amputation results in significant global morbidity and mortality. Australia appears to have a paucity of studies investigating lower extremity amputation. The primary aim of this retrospective study was to investigate key conditions associated with lower extremity amputations in an Australian population. Secondary objectives were to determine the influence of age and sex on lower extremity amputations, and the reliability of hospital coded amputations.MethodsLower extremity amputation cases performed at the Princess Alexandra Hospital (Brisbane, Australia) between July 2006 and June 2007 were identified through the relevant hospital discharge dataset (n = 197). All eligible clinical records were interrogated for age, sex, key condition associated with amputation, amputation site, first ever amputation status and the accuracy of the original hospital coding. Exclusion criteria included records unavailable for audit and cases where the key condition was unable to be determined. Chi-squared, t-tests, ANOVA and post hoc tests were used to determine differences between groups. Kappa statistics were used to measure reliability between coded and audited amputations. A minimum significance level of p < 0.05 was used throughout.ResultsOne hundred and eighty-six cases were eligible and audited. Overall 69% were male, 56% were first amputations, 54% were major amputations, and mean age was 62 ± 16 years. Key conditions associated included type 2 diabetes (53%), peripheral arterial disease (non-diabetes) (18%), trauma (8%), type 1 diabetes (7%) and malignant tumours (5%). Differences in ages at amputation were associated with trauma 36 ± 10 years, type 1 diabetes 52 ± 12 years and type 2 diabetes 67 ± 10 years (p < 0.01). Reliability of original hospital coding was high with Kappa values over 0.8 for all variables.ConclusionsThis study, the first in over 20 years to report on all levels of lower extremity amputations in Australia, found that people undergoing amputation are more likely to be older, male and have diabetes. It is recommended that large prospective studies are implemented and national lower extremity amputation rates are established to address the large preventable burden of lower extremity amputation in Australia.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

What are the key conditions associated with lower limb amputations in a major Australian teaching hospital?

Lazzarini

O'Rourke

Russell

et al. 2012

Journal of Foot and Ankle Research

View full text Add to dashboard Cite

show abstract

“…The study by Gutacker et al focuses on amputations in patients with peripheral artery disease and reports 63 000 lower extremity amputations in Germany in 2005 as well as in 2006; 54% of these patients had endocrine disorders (diabetes) as co-morbidity. Minor to major ratio in this study was 1.46 in 2005 and 1.53 in 2006 [29]. The data as reported by Heller in 2004 give indications of 26 000 to 29 000 lower extremity amputations in individuals with diabetes in the year 2001 [30].…”

Section: Figuresupporting

confidence: 59%

Differences in minor amputation rate in diabetic foot disease throughout Europe are in part explained by differences in disease severity at presentation

Battum¹,

Schaper²,

Prompers³

et al. 2011

Diabetic Medicine

137

118

View full text Add to dashboard Cite

Minor amputation is performed frequently in diabetic foot centres throughout Europe and is determined by depth of the ulcer, peripheral arterial disease, infection and male sex. There are important differences in amputation rate between the European centres, which can be explained in part by severity of disease at presentation. This may suggest that early referral to foot clinics can prevent minor amputations.

show abstract

“…In all, 7.0% of patients had an amputation within the first year. This is in accordance with Gutacker et al, 18 but in the literature the range of one year amputation free survival is wide mainly due to differences in study populations. 18e20 It has previously been reported that age, sex, smoking, comorbidity (hypertension, CVD, and diabetes), and indication for revascularisation are predictors of major amputation in revascularised patients.…”

Section: Trend In Major Amputationsupporting

confidence: 91%

Danish Trends in Major Amputation After Vascular Reconstruction in Patients With Peripheral Arterial Disease 2002–2014

Londero

Høgh

Houlind

et al. 2019

European Journal of Vascular and Endovascular Surgery

View full text Add to dashboard Cite

WHAT THIS PAPER ADDS This population based cohort study provides data on the risk of PAD associated major amputation after revascularisation of the lower limb. Although more revascularisations are performed yearly, levels of major amputation after vascular reconstruction remain high. The risk of amputation is highly associated with the severity of PAD with ulcers/gangrene being the strongest predictor. Geographic variation in risk of amputation after revascularisation is found, but cannot be fully explained by geographic differences in the intensity of vascular treatment.Objective: Contemporary information on major amputations after revascularisation in Denmark is sparse. This population based national study aimed to determine outcomes following revascularisation for PAD and to identify predictors of major amputation after revascularisation, including geographical variation. Methods: Data on patients with PAD undergoing revascularisation (endovascular, open, and hybrid procedures) from 2002 to 2014 were obtained from the Danish Vascular Registry and linked with information from population based healthcare and administrative databases. Cox proportional hazards regression was used to assess the relationship between major amputation and the various associated factors. Results: In all 25,982 first time vascular reconstructions for PAD were performed between 2002 and 2014 and major amputations were performed in 2883 (11.1%) of the patients. The total number of revascularisations increased up to 2010 and thereafter numbers decreased slightly. A trend towards endovascular revascularisation as first time revascularisation was seen (36.6% in 2002 vs. 59.0% in 2014, p < .001). Median time from first revascularisation to major amputation was 4.66 months (range 0.03e146.88 months), and 63.1% of major amputations were performed within one year following revascularisation. No change in the number of amputations performed within one year after revascularisation was found during the study (p ¼ .251). The strongest predictor for major amputations was ulcers/gangrene (HR 8.06, CI 7.11e9.13, p < .001) at the time of revascularisation. Geographic variation for intensity of revascularisation was observed and geographic differences in amputation free survival for patients with intermittent claudication and ulcers/gangrene were found. Conclusion: Although more patients with PAD undergo revascularisation, one in 10 still ends up with a major amputation of the lower limb. The risk of amputation was highly associated with the severity of the vascular disease at the time of revascularisation, with ulcers/gangrene as the strongest predictor. Geographic differences in vascular treatment intensity were found, but these failed to explain the differences in risk of major amputation after revascularisation across catchment areas.

show abstract

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

Cited by 20 publications

References 11 publications

What are the key conditions associated with lower limb amputations in a major Australian teaching hospital?

What are the key conditions associated with lower limb amputations in a major Australian teaching hospital?

Differences in minor amputation rate in diabetic foot disease throughout Europe are in part explained by differences in disease severity at presentation

Danish Trends in Major Amputation After Vascular Reconstruction in Patients With Peripheral Arterial Disease 2002–2014

Contact Info

Product

Resources

About