Lower Extremity Amputation in Germany: Regional Analysis using Nationwide Hospital Discharge Data 2011-2015

Abstract

Amputations reduce irreversibly the quality of life. Health care always aims at avoiding amputations, and the quality of such care provided nationwide should be the same. This study aims to display rates of amputations at the county level and to uncover differences in health care. Using German nationwide hospital discharge data, amputations between 2011 and 2015 were identified. Regional variation is displayed using raw and risk-standardized rates per 100,000 persons. Furthermore, the Systematic Component of Variation (SCV) was computed and Funnel Plots display the Standardized Morbidity Ratio (SMR). The median amputation rate during the observation period was 67 cases per 100,000 persons with a 6-fold variation between counties. Variation between counties remained independent of demographic differences. Higher rates got visible especially within counties in the East and Southeast. The highest systematic variation was seen in amputation heights toe/foot ray (SCV 11.8) and foot complete and mid-/forefoot (SCV 11.7). In Germany, there are significant regional variations of amputation rates at the county level. The systematic variation is strongest within peripheral amputation heights. Especially in the East and Southeast of Germany, clusters of high amputation rates give insights in the potential regional need for improvement.