Trends in Major Lower Limb Amputation Related to Peripheral Arterial Disease in Hungary: A Nationwide Study (2004–2012)

Abstract

According to this whole population based study from Hungary, the incidence of lower limb major amputation is high with no change over the past 9 years. An explanation for this remains to be determined, as the traditional risk factors in Hungary do not account for it. The characteristics of major amputation (the rate of primary amputation, the ratio of below to above knee amputation and the age of the affected population) underline the importance of screening, early detection, improved vascular care and an optimal revascularization policy. Standardization and validation of amputation detection methods and reporting is essential.

Incidence rates of dysvascular lower extremity amputation changes in Northern Netherlands: A comparison of three cohorts of 1991-1992, 2003-2004 and 2012-2013

“…To our knowledge, this is one of the few studies in which the data were extracted through patients’ records directly. To put the numbers in an international perspective, the decrease of major LEA incidence our study is similar to several recent studies[ 5 , 9 , 34 , 37 ]. Decreased major LEA incidence rates in the overall population were reported: from 23.3 to 16.0 per 100.000 person-years in Germany[ 5 ], from 23 to 12 per 100.000 person-years in the United States[ 37 ], from 14 to 9 per 100.000 person-years in Australia[ 38 ], whereas unchanged rates of 42.3 per 100.000 person-years were reported in Hungary[ 9 ].…”

“…To put the numbers in an international perspective, the decrease of major LEA incidence our study is similar to several recent studies[ 5 , 9 , 34 , 37 ]. Decreased major LEA incidence rates in the overall population were reported: from 23.3 to 16.0 per 100.000 person-years in Germany[ 5 ], from 23 to 12 per 100.000 person-years in the United States[ 37 ], from 14 to 9 per 100.000 person-years in Australia[ 38 ], whereas unchanged rates of 42.3 per 100.000 person-years were reported in Hungary[ 9 ]. Similar to our findings for the DM populations, recent studies reported decreased major LEA incidences: in Italy from 109 to 83 per 100.000 person-years[ 8 ], in Scotland from 187 to 111 per 100.000 person-years[ 39 ], in Finland from 94.4 to 48.3 per 100.000 person-years[ 36 ], whereas in Ireland[ 10 ] and the United Kingdom[ 35 ] unchanged incidence rates were reported, respectively 47 and 102 per 100.000 person-years.…”

“…However, differences in research methodology (e.g., definition of amputation levels) may also contribute to the variation of the reported incidences[ 4 ]. Recent studies report decreasing incidence rates of major LEA in Western European countries such as Germany[ 5 ], Spain[ 6 ], the United Kingdom[ 7 ], and Italy[ 8 ], while unchanged rates are reported in Hungary[ 9 ] and Ireland[ 10 ].…”

Análise dos fatores de risco relacionados às amputações maiores e menores de membros inferiores em hospital terciário

“…Several different studies have observed reductions in overall incidence of major amputations and related it to better control of diabetes (despite the increase in diabetes incidence) and better governmental public health strategies, such as creation of multidisciplinary teams for treatment of the diabetic foot and expansion of healthcare networks. 10,14,15,[29][30][31] The present cross-sectional and single-center study was unable to determine efficacy of public health initiatives with relation to amputations.…”

“…9 Major amputations are generally defined as those performed above the level of the ankle, whether transtibial, transfemoral, knee disarticulations or hip disarticulations, while minor amputations are those restricted to the toes or at the level of the foot (whether transmetatarsal amputations, tarsometatarsal or Lisfranc disarticulations, or mid-tarsal or Chopart disarticulations). 10 Minor amputations are generally better accepted because they do not necessarily impose a need for prostheses to enable walking. 11 Mortality rates differ between the two groups, varying from 22% within 1 year for minor amputations 12 to 21% within 1 month up to 52% within 1 year for major amputations.…”