BACKGROUND: Conflicting data exist regarding changes in amputation rates in patients with ulcers because of diabetes mellitus (DM) and peripheral artery disease (PAD). This study focuses on how population-based amputation rates are changing in the current treatment era. METHODS: Using the California Office of Statewide Health Planning and Development Patient Discharge database, all patients who underwent major nontraumatic lower extremity (LE) amputation in 2005 through 2011 were identified. Age-adjusted population-based amputation risk was determined by year. Gender and age trends in amputation risk were estimated separately for diabetes-related amputations and PAD-related amputations, treating all California residents as the population at risk. RESULTS: From 2005 to 2011, 32,025 qualifying amputations were performed in California. Of these, 11,896 were DM-associated (n = 1,095), PAD-associated (n = 4,335), or associated with both conditions (n = 6,466). PAD-associated amputation rates and combined PAD/DM-associated amputation rates have changed little since 2009 after decreasing substantially over the prior 5 years, but DM-associated amputation rates have continuously increased since 2005. California residents older than the age of 80 years had the most dramatic decrease in PAD-associated amputation rates from 2005 to 2011 (i.e., from 317 to 175 per million Californians). Men with PAD/DM had amputation rate 1.5 times higher than those of patients with PAD alone and 5 times higher than rates of DM patients. In women the difference between patient with PAD and PAD/DM was not seen; however, these rates were 2.5 times higher than patients with DM alone. CONCLUSIONS: Preventable amputations associated with high-risk diseases are no longer decreasing despite continuing advances in care and education. Octogenarians with PAD represent the highest risk group for amputation, but DM-associated amputations have increased since 2005. Further research to understand treatment pathways for patient with LE wounds may shed light on pathways for amputation prevention in the future.
BACKGROUND: Conflicting data exist regarding changes in amputation rates in patients with ulcers because of diabetes mellitus (DM) and peripheral artery disease (PAD). This study focuses on how population-based amputation rates are changing in the current treatment era. METHODS: Using the California Office of Statewide Health Planning and Development Patient Discharge database, all patients who underwent major nontraumatic lower extremity (LE) amputation in 2005 through 2011 were identified. Age-adjusted population-based amputation risk was determined by year. Gender and age trends in amputation risk were estimated separately for diabetes-related amputations and PAD-related amputations, treating all California residents as the population at risk. RESULTS: From 2005 to 2011, 32,025 qualifying amputations were performed in California. Of these, 11,896 were DM-associated (n = 1,095), PAD-associated (n = 4,335), or associated with both conditions (n = 6,466). PAD-associated amputation rates and combined PAD/DM-associated amputation rates have changed little since 2009 after decreasing substantially over the prior 5 years, but DM-associated amputation rates have continuously increased since 2005. California residents older than the age of 80 years had the most dramatic decrease in PAD-associated amputation rates from 2005 to 2011 (i.e., from 317 to 175 per million Californians). Men with PAD/DM had amputation rate 1.5 times higher than those of patients with PAD alone and 5 times higher than rates of DMpatients. In women the difference between patient with PAD and PAD/DM was not seen; however, these rates were 2.5 times higher than patients with DM alone. CONCLUSIONS: Preventable amputations associated with high-risk diseases are no longer decreasing despite continuing advances in care and education. Octogenarians with PAD represent the highest risk group for amputation, but DM-associated amputations have increased since 2005. Further research to understand treatment pathways for patient with LE wounds may shed light on pathways for amputation prevention in the future.
Authors: L Norgren; W R Hiatt; J A Dormandy; M R Nehler; K A Harris; F G R Fowkes; Kevin Bell; Joseph Caporusso; Isabelle Durand-Zaleski; Kimihiro Komori; Johannes Lammer; Christos Liapis; Salvatore Novo; Mahmood Razavi; Johns Robbs; Nicholaas Schaper; Hiroshi Shigematsu; Marc Sapoval; Christopher White; John White; Denis Clement; Mark Creager; Michael Jaff; Emile Mohler; Robert B Rutherford; Peter Sheehan; Henrik Sillesen; Kenneth Rosenfield Journal: Eur J Vasc Endovasc Surg Date: 2006-11-29 Impact factor: 7.069
Authors: Maria E Craig; Craig Jefferies; Dana Dabelea; Naby Balde; Anju Seth; Kim C Donaghue Journal: Pediatr Diabetes Date: 2014-09 Impact factor: 4.866
Authors: Paul N Suding; William McMaster; Edward Hansen; Arthur W Hatfield; Ian L Gordon; Samuel Eric Wilson Journal: Ann Vasc Surg Date: 2008-03 Impact factor: 1.466
Authors: Kathryn Ziegler-Graham; Ellen J MacKenzie; Patti L Ephraim; Thomas G Travison; Ron Brookmeyer Journal: Arch Phys Med Rehabil Date: 2008-03 Impact factor: 3.966
Authors: W Schuyler Jones; Manesh R Patel; David Dai; Sumeet Subherwal; Judith Stafford; Sarah Calhoun; Eric D Peterson Journal: J Am Coll Cardiol Date: 2012-10-24 Impact factor: 24.094
Authors: Derek LeRoith; Geert Jan Biessels; Susan S Braithwaite; Felipe F Casanueva; Boris Draznin; Jeffrey B Halter; Irl B Hirsch; Marie E McDonnell; Mark E Molitch; M Hassan Murad; Alan J Sinclair Journal: J Clin Endocrinol Metab Date: 2019-05-01 Impact factor: 5.958
Authors: Anouk Déruaz-Luyet; Christina Raabe; Elizabeth M Garry; Kimberly G Brodovicz; Lawrence A Lavery Journal: Diabetes Obes Metab Date: 2020-03-11 Impact factor: 6.577