Progression of disease preceding lower extremity amputation in Denmark: a longitudinal registry study of diagnoses, use of medication and healthcare services 14 years prior to amputation

Abstract

ObjectivesPatients with non-traumatic lower extremity amputation are characterised by high age, multi-morbidity and polypharmacy and long-term complications of atherosclerosis and diabetes. To ensure early identification of patients at risk of amputation, we need to gain knowledge about the progression of diseases related to lower extremity amputations during the years preceding the amputation.DesignA retrospective population-based national registry study.SettingThe study includes data on demographics, diagnoses, surgery, medications and healthcare services from five national registries. Data were retrieved from 14 years before until 1 year after the amputation. Descriptive statistics were used to describe the progression of diseases and use of medication and healthcare services.ParticipantsAn unselected cohort of patients (≥50 years; n=2883) subjected to a primary non-traumatic lower extremity amputation in 2010 or 2011 in Denmark.ResultsThe prevalence of atherosclerosis, hypertension and diabetes was 70%, 53% and 49%, respectively. Among patients with atherosclerosis, 42% had not received cholesterol-lowering treatment even though 87% had visited their general practitioner within the last year prior to amputation. Further, 16% were diagnosed with diabetes at the time of the amputation. The prevalence of cardiovascular diseases increased from 22% to 70%, atherosclerosis from 5% to 53% and diabetes from 17% to 35% over the 14 years preceding major amputation. Of all patients, 64% had been in contact with the hospital or outpatient clinics within the last 3 years, and 29% received a prescription of opioids 3 years prior to the amputation.ConclusionAmong patients with non-traumatic lower extremity amputation, one-third live with undiagnosed and untreated atherosclerosis and one-sixth suffer from undiagnosed diabetes despite continuous contacts to general practitioner and the hospital. This study emphasises a need for enhanced focus, among both hospital clinicians and general practitioners, on the early identification of atherosclerosis and diabetes.

Impact of Preoperative Symptoms and Revascularized Arterial Segment in Patients With Chronic Limb-Threatening Ischemia

“…66 A recent Danish study analyzing level of amputation and the risk of mortality found that more proximal amputations were associated with a higher risk of death. 39 In our work, we did not find higher amputation rates following proximal revascularizations-rather the opposite, even though these associations disappeared when we adjusted for comorbidities. A more proximal revascularization might rather be a surrogate measure of a more widespread atherosclerotic disease.…”

<p>Analysis of the Peri-Operative Cost of Non-Traumatic Major Lower Extremity Amputation in Jordan</p>

“…CLI was defined as the presence of rest pain or tissue loss (ICD-9-CM code 440. [22][23][24]. Major lower extremity amputation was defined as any amputation above the ankle joint (ICD9-CM: codes 84.…”

Does closed incision negative wound pressure therapy in non‐traumatic major lower‐extremity amputations improve survival rates?

“…7,8 In Denmark, 30-day mortality has been reported to be 16% to 35% and 1-year mortality to be 37% to 59% [9][10][11] in this frail group of patients. They suffer from long-term complications of atherosclerosis and diabetes resulting in ischaemia and infected and necrotic wounds.…”

“…They suffer from long-term complications of atherosclerosis and diabetes resulting in ischaemia and infected and necrotic wounds. 7,8 In Denmark, 30-day mortality has been reported to be 16% to 35% and 1-year mortality to be 37% to 59% [9][10][11] in this frail group of patients.…”