Abstract
AimsTo describe the incidence, mortality, and trend of major lower extremity amputations (LEA) and to assess risk factors of all-cause mortality after major LEA in individuals with diabetes. MethodsProcedure codes of major LEA were extracted from the Austrian Health Insurance database (N = 507,180) during 2014–2017 to estimate crude and age-standardized rates per 100,000 population. Short- (30-day, 90-day) and long-term (1-year, 5-year) all-cause mortality after major LEA was estimated from the date of amputation till the date of death. ResultsThe age-standardized rate of major LEA was 6.44 with an insignificant annual change of 3% (p = 0.825) from 2014 to 2017. Cumulative 30-day mortality was 13.5%, 90-day 22.0%, 1-year 34.4%, and 5-year 66.7%. Age, male sex, above-knee amputation, Charlson index, and heart failure were significantly associated with both short- and long-term mortality. Cancer, dementia, heart failure, peripheral vascular disease, and renal disease were associated with long-term mortality. ConclusionsThe rate of major LEA in individuals with diabetes remained stable during 2014–2017 in Austria. Short- and long-term mortality rates were considerably high after major LEA. Old age, male sex, above-knee amputations, and Charlson Index were significant predictors of both short- and long-term mortality and comorbidities were significant predictors of long-term mortality only.
Highlights
Lower extremity amputation (LEA) is a debilitating procedure that contributes to significant healthcare costs, loss of mobility, reduced quality of life, and mortality [1,2,3,4]
The Austrian Health Insurance (AHI) database covers 99% of the Austrian population and contains pseudoanonymized information on demographic characteristics, primary and secondary medical diagnosis recorded as International Classification of Disease (ICD) codes along with discharge dates from hospitals, prescribed medications coded as Anatomical Therapeutic Classification (ATC) system introduced by the World Health Organization (WHO), along with their dosage, volume, start dates, and end dates, medical procedures recorded as MEL codes along with dates of procedures and dates of discharge after procedures, and all-cause mortality along with the date of death
Only congestive heart failure (CHF) was a significant risk factor of both short-term and long-term mortality, while peripheral vascular disease (PVD), renal disease, dementia, cancer, and a composite Cardiovascular disease (CVD) were significant risk factors of long-term (1-year and 5-year) mortality only. This is the first study delineating the epidemiology of major LEA in individuals with diabetes in Austria using the nationally representative health insurance database
Summary
Lower extremity amputation (LEA) is a debilitating procedure that contributes to significant healthcare costs, loss of mobility, reduced quality of life, and mortality [1,2,3,4]. An estimated 75% of the total LEA are performed in individuals with diabetes. The risk of undergoing LEA is 15–45 times higher in individuals with diabetes than those without diabetes [5,6]. 85% of LEA occur as a complication of diabetic foot ulcer (DFU), which is mainly caused by inadequate glucose control, peripheral artery disease, infection management, and polyneuropathy [7,8,9,10]
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