Time Trends in the Incidence of Long-Term Mortality in T2DM Patients Who Have Undergone a Lower Extremity Amputation. Results of a Descriptive and Retrospective Cohort Study.

Ana López-De-Andrés,Isabel Jiménez-Trujillo,Rodrigo Jiménez-García,Maria D Esteban-Vasallo,Javier De Miguel-Diez,Maria A Palomar-Gallego,Javier Aragon-Sánchez,Martin Romero-Maroto,Valentin Hernández-Barrera,Napoleón Perez-Farinos

doi:10.3390/jcm8101597

Abstract

(1) Background: The aims of this study were to examine the incidence of lower extremity amputations (LEAs) among patients with type 2 diabetes mellitus (T2DM) and to compare the mortality risk of diabetic individuals who underwent LEA with age and sex-matched diabetic individuals without LEA. (2) Methods: We performed a descriptive observational study to assess the trend in the incidence of LEA and a retrospective cohort study to evaluate whether undergoing LEA is a risk factor for long-term mortality among T2DM patients. Data were obtained from the Hospital Discharge Database for the Autonomous Community of Madrid, Spain (2006–2015). (3) Results: The incidence rates of major below-knee and above-knee amputations decreased significantly from 24.9 to 17.1 and from 63.9 to 48.2 per 100000 T2DM individuals from 2006 to 2015, respectively. However, the incidence of minor LEAs increased over time. Mortality was significantly higher among T2DM patients who underwent LEA compared with those who did not undergo this procedure (HR 1.75; 95% CI 1.65–1.87). Male sex, older age, and comorbidity were independently associated with higher mortality after LEA. (4) Conclusions: Undergoing a LEA is a significant risk factor for long term mortality among T2DM patients, and those who underwent a major above-knee LEAs have the highest risk.

Highlights

Lower extremity amputation (LEA) is one of the most serious surgical procedures performed in patients with diabetes [1]
Mortality was significantly higher among type 2 diabetes mellitus (T2DM) patients who underwent LEA compared with those who did not undergo this procedure (HR 1.75; 95% CI 1.65–1.87)
The aims of our study were to assess the trend in the incidence of LEA among T2DM patients living in the Autonomous Community of Madrid from 2006 to 2015, and to compare the mortality risk

Summary

Introduction

Lower extremity amputation (LEA) is one of the most serious surgical procedures performed in patients with diabetes [1]. Patients with diabetes are more likely to require LEA than people without diabetes [2]. In a national Spanish study between 2001 and 2012, 65.8% of all nontraumatic LEA procedures occurred in patients with diabetes [3]. Neuropathy and PVD often co-exist and may lead to neuro-ischemic ulceration [4,5,6]. The prevalence of PVD among people with diabetes has risen steadily throughout the past three decades, and PVD is estimated to be present in as many as 50%–60% of patients with diabetic foot ulcers (DFUs) [5]. Studies have shown that the identification of PVD in patients with DFUs and aggressive, timely revascularization reduces amputation rates [4,5]

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