An International Comparison of Lower Extremity Amputation Rates

Renzi, Ronald; Unwin, Nigel; Jubelirer, Robert A.; Haag, Lester

doi:10.1007/s10016-006-9044-9

Cited by 34 publications

(18 citation statements)

References 6 publications

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“…The incidence of amputation in this Swedish population increased with age in both men and women, but the mean age at initial amputation was lower for men than for women-a finding also shown in other studies (18). Our study showed a significantly higher risk for amputation in diabetic men aged Ն85 years.…”

Section: Conclusion -T H I Ssupporting

confidence: 87%

“…However, the definitions of "major" and "minor" amputation used in various studies have been inconsistent, making comparisons difficult. For example, a major amputation has been defined in various studies as one extending from the tarsometatarsal joint (19), the "midfoot" (18), or the ankle (Symes) (8) and even beginning from the transtibial level (9). Furthermore, incidence rates based on amputations from the transmetatarsal level that exclude the most distal amputations are probably more accurate and have greater clinical significance with regard to the effects on functional mobility of the patients and the total cost of hospitalization (25).…”

Section: Conclusion -T H I Smentioning

confidence: 99%

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Incidence of Lower-Limb Amputation in the Diabetic and Nondiabetic General Population

et al. 2009

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OBJECTIVE -The purpose of this study was to compare the incidence of vascular lowerlimb amputation (LLA) in the diabetic and nondiabetic general population. RESEARCH DESIGN AND METHODS-A population-based cohort study was conducted in a representative Swedish region. All vascular LLAs (at or proximal to the transmetatarsal level) performed from 1997 through 2006 were consecutively registered and classified into initial unilateral amputation, contralateral amputation, or reamputation. The incidence rates were estimated in the diabetic and nondiabetic general population aged Ն45 years.RESULTS -During the 10-year period, LLA was performed on 62 women and 71 men with diabetes and on 79 women and 78 men without diabetes. The incidence of initial unilateral amputation per 100,000 person-years was 192 (95% CI 145-241) for diabetic women, 197 (152-244) for diabetic men, 22 (17-26) for nondiabetic women, and 24 (19 -29) for nondiabetic men. The incidence increased from the age of 75 years. Of all amputations, 74% were transtibial. The incidences of contralateral amputation and of reamputation per 100 amputeeyears in diabetic women amputees were 15 (7-27) and 16 (8 -28), respectively; in diabetic men amputees 18 (10 -29) and 21 (12-32); in nondiabetic women amputees 14 (7-24) and 18 (10 -28); and in nondiabetic men amputees 13 (6 -22) and 24 (15-35).CONCLUSIONS -In the general population aged Ն45 years, the incidence of vascular LLA at or proximal to the transmetatarsal level is eight times higher in diabetic than in nondiabetic individuals. One in four amputees may require contralateral amputation and/or reamputation. Diabetes Care 32:275-280, 2009

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Section: Conclusion -T H I Ssupporting

confidence: 87%

Section: Conclusion -T H I Smentioning

confidence: 99%

Incidence of Lower-Limb Amputation in the Diabetic and Nondiabetic General Population

et al. 2009

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“…Furthermore, whilst major amputation rates in predominantly white areas decreased from 14 to 12 per 10 5 , incidence in predominantly African‐American areas rose from 59 to 65 per 10 5 (1987–2004) [38]. Overall, major amputation rates are higher in the USA compared with the rest of the world at 23.6 vs. 14.2 per 10 5 males and 15.2 vs. 6.7 per 10 5 females [29].…”

Section: Discussionmentioning

confidence: 99%

“…In the studies presented here, the denominator is not constant but the message is clear: diabetes mellitus greatly increases incidence and mortality of lower extremity amputation. Diabetes, infection and peripheral vascular disease are known to be the predominant causes of non-healing foot ulcers [27], which in turn is the principal cause of lower extremity amputation both in the UK and USA [28,29]. Discrepancies in lower extremity amputation rates on a national level may be caused by differences in vascular-diabetic service provision and regional clinical practice [30].…”

Section: Discussionmentioning

confidence: 99%

Lower extremity amputations - a review of global variability in incidence

et al. 2011

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Significant global variation exists in the incidence of lower extremity amputation. Ethnicity and social deprivation play a significant role but it is the role of diabetes and its complications that is most profound. Lower extremity amputation reporting methods demonstrate significant variation with no single standard upon which to benchmark care. Effective standardized reporting methods of major, minor and at-risk populations are needed in order to quantify and monitor the growing multidisciplinary team effect on lower extremity amputation rates globally.

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“…The direct costs associated with LEAs in Brazil are approximately $US128 m/year—a very heavy burden. Amputation rates vary widely across different countries [27,28] and can be considered a marker of disease management. A high number of major amputations is a clear sign of poor foot care.…”

Section: Discussionmentioning

confidence: 99%