The National Hospital Discharge Register Data on Lower Limb Amputations

Winell, Klas; Niemi, Marja; Lepäntalo, Mauri

doi:10.1016/j.ejvs.2005.12.025

Cited by 29 publications

(18 citation statements)

References 12 publications

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“…Similar observations have been made in otherl arge diabetic population studies as well (14,15). The results from Southern Finland aretowards the same direction, both in diabetics and non-diabetics, but not as good as than in Denmark (16).…”

supporting

confidence: 77%

Invited Commentary

Lepäntalo

2008

Scand J Surg

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supporting

confidence: 77%

Invited Commentary

Lepäntalo

2008

Scand J Surg

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“…A 41% decrease was reported for Southern Finland from 1984 to 2000 (15). The crude incidence for any first lower limb amputation among individuals with diabetes in Finland decreased from 924 to 387 per 100,000 from 1988 to 2002 (16). In our data, the incidence of the first major amputation has dropped significantly, as in many other reports (17,18), but even faster declines have been reported (8–11).…”

Section: Discussionmentioning

confidence: 99%

Fewer Major Amputations Among Individuals With Diabetes in Finland in 1997–2007

Ikonen

Sund

Venermo³

et al. 2010

Diabetes Care

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OBJECTIVEComplications occur in diabetes despite rigorous efforts to control risk factors. Since 2000, the National Development Programme for the Prevention and Care of Diabetes has worked to halve the incidence of amputations in 10 years. Here we evaluate the impact of the efforts undertaken by analyzing the major amputations done in 1997–2007.RESEARCH DESIGN AND METHODSAll individuals with diabetes (n = 396,317) were identified from comprehensive national databases. Data on the first major amputations (n = 9,481) performed for diabetic and nondiabetic individuals were obtained from the National Hospital Discharge Register.RESULTSThe relative risk for the first major amputation was 7.4 (95% CI 7.2–7.7) among the diabetic versus the nondiabetic population. The standardized incidence of the first major amputation decreased among the diabetic and nondiabetic populations (48.8 and 25.2% relative risk reduction, respectively) over 11 years, and the time from the registration of diabetes to the first major amputation was significantly longer, on average 1.2 years more. The cumulative five-year postamputation mortality among diabetic individuals was 78.7%.CONCLUSIONSIn our nationwide diabetes database, the duration from the registration of diabetes to the first major amputation increased, and the incidence of major amputations decreased almost 50% in 11 years. Approximately half of this change was due to the increasing size of the diabetic population. The risk for major amputation is more than sevenfold that among the nondiabetic population. These results pose a continuous challenge to improve diabetes care.

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“…In Finland, Winell published results from a hospital discharge database in which information was provided regarding amputations and vascular operations [19]. Diabetes specific information was used to calculate the denominator and the amputation rate was found to decrease from 92.4 to 38.7 per 10 000 people with diabetes.…”

Section: Descriptive Studies Are Still the Cornerstonementioning

confidence: 99%

Amputations and ulceration; pitfalls in assessing incidence

Houtum

2008

Diabetes Metab. Res. Rev.

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In order to direct scientific research, it is pivotal to know the extent of a clinical problem. Therefore, much effort has been undertaken to tally all diabetic foot problems around the world. Incidence and prevalence figures concerning both foot ulcerations and lower extremity amputations have been reported extensively worldwide. The figures presented are being compared with those from other countries, regions or clinics and those with the lowest numbers are deemed best practices.However, for these comparisons to be valid there are many possible pitfalls that are to be considered. A significant number of epidemiological and clinical considerations are to be dealt with and many of these are extremely important to realize when comparing ulceration or amputation rates. The influence of using a certain definition of nominators and denominators are explained. Also, the clinical setting in which the research has been performed is of importance. Many possible pitfalls are discussed in this presentation. Although there are limitations to this type of research, it may be the only way possible to go. In order to compare health strategies in certain areas of the world or to determine the importance of an intervention, incidence and prevalence figures certainly may prove a beneficial effect and therefore justify an intervention. Therefore, given the limitations epidemiological research concerning the prevalence and incidence of foot-related complications still forms the backbone of clinical research in the area of the diabetic foot.

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The National Hospital Discharge Register Data on Lower Limb Amputations

Abstract: The incidence of major amputation is declining in the diabetic population. This positive development can be explained by more active vascular operative treatment. Regional differences are wider than acceptable.

Cited by 29 publications

References 12 publications

Invited Commentary

Invited Commentary

Fewer Major Amputations Among Individuals With Diabetes in Finland in 1997–2007

Amputations and ulceration; pitfalls in assessing incidence

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