National trends in incidence and outcomes in lower extremity amputations in people with and without diabetes in Spain, 2001–2012

López‐de‐Andrés, Ana; Jiménez-García, Rodrigo; Aragón‐Sánchez, Javier; Jiménez‐Trujillo, Isabel; Hernández-Barrera, Valentín; Méndez‐Bailón, Manuel; Miguel‐Yanes, José M. de; Pérez-Farinós, Napoleón; Carrasco‐Garrido, Pilar

doi:10.1016/j.diabres.2015.01.010

Cited by 47 publications

(81 citation statements)

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“…The overall incidence of amputations due to diabetes increased by 4.29% in Spain between 2001 and 2004, followed by a downward trend until 2012, around 2% [7]. In-hospital mortality due to amputations remained stable between 2001 and 2012, around 10%, resulting in an economic cost of 33% of the total cost spent in hospital treatment of T2DM complications [8].…”

Section: Introductionmentioning

confidence: 99%

Major amputations in type 2 diabetes between 2001 and 2015 in Spain: regional differences

Pérez¹,

Chines

García³

et al. 2020

BMC Public Health

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Background: To analyze the trend of lower extremity major amputations (MA) among patients with type 2 diabetes mellitus (T2DM) in the Regions of Spain from year 2001 until 2015.Methods: Descriptive study of 40,392 MA. Data were obtained from the national hospital discharge database in patients with T2DM. The incidence rate was calculated in each Region, in addition to the incidence ratios (IR) between annual incidence and incidence of the year 2001. The length of hospital stay and mortality risks were analyzed using regression models adjusted for sex, age and smoking. Results: The major amputations incidence rate per 100,000 person-years was 0.48 in Spain; Canary Islands showed the highest incidence (0.81). The trend was a slight decrease or stability of the incidence in all Regions except in the Canary Islands (IR 2015 = 2.0 [CI95% = 1.5, 2.6]) and in Madrid (IR 2015 = 0.1 [CI95% = 0.1, 0.2]). Mortality after major amputations was 10% in Spain; Cantabria suffered the highest risk of death [1.7 (CI95% = 1.4; 2.1), p < 0.001] and La Rioja the lowest risk (0.5 [CI95% = 0.2; 0.9]; p = 0.026). The longest hospital stay was registered in the Canary Islands [(CI95% = 11.4;13.3], p < 0.001)], and the shortest in the Valencian Community [(CI95% = − 7.3; − 5.8), p < 0.001)]. Conclusion: MA in T2DM followed a growing trend in the Canary Islands, which diverged from the downward trend in Spain. The variability of mortality and hospital stay, suggest to review the clinical management in some Regions. Sudden incidence decrease in Madrid suggests checking the record procedures of hospital discharges.

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Section: Introductionmentioning

confidence: 99%

Major amputations in type 2 diabetes between 2001 and 2015 in Spain: regional differences

Pérez¹,

Chines

García³

et al. 2020

BMC Public Health

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“…In Spain, more than 5,000 major LEAs are performed yearly, 57% in patients with type 2 diabetes (T2DM) [8]. Despite improvements in long-term outcome, in-hospital mortality (IHM) following major LEA in patients with T2DM has remained stable from 2001 to 2012 with figures of 9.7% and 9.5% respectively [8, 9].…”

Section: Introductionmentioning

confidence: 99%

“…Despite improvements in long-term outcome, in-hospital mortality (IHM) following major LEA in patients with T2DM has remained stable from 2001 to 2012 with figures of 9.7% and 9.5% respectively [8, 9]. …”

Section: Introductionmentioning

confidence: 99%

Predictors of in-hospital mortality following major lower extremity amputations in type 2 diabetic patients using artificial neural networks

López‐de‐Andrés

Hernández‐Barrera

López³

et al. 2016

BMC Med Res Methodol

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BackgroundOutcome prediction is important in the clinical decision-making process. Artificial neural networks (ANN) have been used to predict the risk of post-operative events, including survival, and are increasingly being used in complex medical decision making. We aimed to use ANN analysis to estimate predictive factors of in-hospital mortality (IHM) in patients with type 2 diabetes (T2DM) after major lower extremity amputation (LEA) in Spain.MethodsWe design a retrospective, observational study using ANN models. We used the Spanish National Hospital Discharge Database to select all hospital admissions of major LEA procedure in T2DM patients. Main outcome measures: Predictors of IHM using 4 ANN models: i) with all discharge diagnosis included in the database; ii) with all discharge diagnosis included in the database, excluding infectious diseases; iii) comorbidities included in the Charlson Comorbidities Index; iv) comorbidities included in the Elixhauser Comorbidity Index.ResultsFrom 2003 to 2013, 40,857 major LEAs in patients with T2DM were identified with a 10.0% IHM. We found that Elixhauser Comorbidity Index model performed better in terms of sensitivity, specificity and precision than Charlson Comorbidity Index model (0.7634 vs 0.7444; 0.9602 vs 0.9121; 0.9511 vs 0.888, respectively). The area under the ROC curve for Elixhauser comorbidity model was 91.7% (95% CI 90.3–93.0) and for Charlson comorbidity model was 88.9% (95% CI; 87.590.2) p = 0.043. Models including all discharge diagnosis with and without infectious diseases showed worse results. In the Elixhauser Comorbidity Index model the most sensitive parameter was age (variable sensitive ratio [VSR] 1.451) followed by female sex (VSR 1.433), congestive heart failure (VSR 1.341), renal failure (VSR 1.274) and chronic pulmonary disease (VSR 1.266).ConclusionsElixhauser Comorbidity Index is a superior comorbidity risk-adjustment model for major LEA survival prediction in patients with T2DM than Charlson Comorbidity Index model using ANN models. Female sex, congestive heart failure, and renal failure are strong predictors of mortality in these patients.

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“…Az alsó végtagi major amputációkat (boka feletti) tekintve diabetes esetén a közölt incidenciatartomány 5,6-600/100 000, cukorbetegség nélkül 3,6-58,7/100 000. Az összefoglaló tanulmány megjelenése óta megjelent publikációk adatai a fenti incidenciatartományok értékeit nem módosították [14][15][16][17][18][19][20][21][22].…”

Section: Alsó Végtagi Amputációk: Előfordulás Trendek a Világbanunclassified

“…Ezek többsége a megfigyelési idő-szakban mérsékelt incidenciacsökkenést jelez. Ennek megfelelő, csökkenő incidenciaadatokat közölt az Amerikai Egyesült Államok [20], Olaszország [15], Svédor-szág [25], Németország [16], Finnország [17], Ausztrá-lia [26], Spanyolország [14], Egyesült Királyság [21]. A közzétett adatok a csökkenés mértékét tekintve eltérő-ek, az egy évre vonatkozó csökkenés mértéke jellemzően 5% alatti.…”

Section: Alsó Végtagi Amputációk: Előfordulás Trendek a Világbanunclassified

A perifériás verőérbetegséggel és a cukorbetegséggel összefüggő alsó végtagi amputációk. Epidemiológiai adatok bemutatása és a megelőző stratégia lehetőségeinek elemzése

Járai

Farkas

2016

Orvosi Hetilap

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Az alsó végtagi amputáció, mint a perifériás verőérbetegség és a cukorbetegség egyik legsúlyosabb következménye, kiemelt figyelmet érdemel. Az összefoglaló közlemény célja a magyar és a nemzetközi amputációs adatok összehason-lítása. Szembesülve azzal, hogy az előfordulásra, időbeni trendekre vonatkozó globális amputációs adatok rendkívül változékonyak, az összefoglaló elemzi a variabilitás lehetséges meghatározó jellemzőit. E faktorok közé tartoznak a tanulmányok közlési módjának különbözőségei, az érintett népesség demográfiai, epidemiológiai, gazdasági, társa-dalmi és kulturális tényezői, valamint az egészségügyi szolgáltatás minőségében tapasztalt eltérések. Az amputációs kockázat értelmezhető egyfajta élettartam-kockázatként, ami a különböző kockázati faktorok időben változó mintá-zatának eredménye. Ebben az értelemben a hatékony megelőző stratégiai tervezés összetett intézkedési lépéseket igényel, ami több tudományág kooperációját, időben elkezdett megelőző intézkedések kezdeményezését, valamint központosított érbetegellátás kialakítását feltételezi. Az alsó végtagi amputációkkal kapcsolatban a kutatás-fejlesztés egyértelmű prioritás, ami segíthet ennek a rendkívül összetett, kiemelt népegészségügyi jelentőséggel bíró kérdésnek a pontosabb megértésében. Orv. Hetil., 2016, 157(32), 1266-1274. Kulcsszavak: alsó végtagi amputáció, perifériás érbetegség, diabeteses láb Peripheral arterial disease and diabetes related lower limb amputations Presentation of the epidemiological data and the analysis of potentialities in preventive strategyLower limb amputation as one of the most devastating consequences of peripheral arterial disease and diabetes mellitus needs peculiar attention. This review aims at comparing Hungarian and international amputation data. Realizing the great variability of the global amputation incidence and trends data, the main determinants of this variety are assessed. These factors involve methodological differences in reporting, demographic, epidemiological, economic, societal and cultural variation of the affected populations and differences in the health care service. The amputation hazard can be considered as an example of lifetime risk that can be characterized by complex interaction of contionuously changing risk factor pattern. In that sense an effective preventive strategy planning needs complex measure implementations that associate with multidisciplinary approach, timely complex preventive interventions and centralized vascular care. Research and development on amputation field shows clear priority that can contribute to the better understanding of this extremely complex scenario with significant public health consequences. Keywords: lower limb amputation, peripheral arterial disease, diabetic footKolossváry, E., Járai, Z., Farkas, K. [Peripheral arterial disease and diabetes related lower limb amputations. Presentation of the epidemiological data and the analysis of potentialities in preventive strategy].

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National trends in incidence and outcomes in lower extremity amputations in people with and without diabetes in Spain, 2001–2012

Cited by 47 publications

References 32 publications

Major amputations in type 2 diabetes between 2001 and 2015 in Spain: regional differences

Major amputations in type 2 diabetes between 2001 and 2015 in Spain: regional differences

Predictors of in-hospital mortality following major lower extremity amputations in type 2 diabetic patients using artificial neural networks

A perifériás verőérbetegséggel és a cukorbetegséggel összefüggő alsó végtagi amputációk. Epidemiológiai adatok bemutatása és a megelőző stratégia lehetőségeinek elemzése

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