Abstract
(1) Background: To examine trends in the incidence (2001–2019), clinical characteristics and in-hospital outcomes following major and minor non-traumatic lower-extremity amputations (LEAs) among people with type 2 diabetes mellitus (T2DM) in Spain, assessing possible sex differences. (2) Methods: Retrospective cohort study using data from the Spanish National Hospital Discharge Database. Joinpoint regression was used to estimate incidence trends, and multivariable logistic regression to estimate factors associated with in-hospital mortality (IHM). (3) Results: LEA was coded in 129,059 patients with T2DM (27.16% in women). Minor LEAs accounted for 59.72% of amputations, and major LEAs comprised 40.28%. The adjusted incidences of minor and major LEAs were higher in men than in women (IRR 3.51; 95%CI 3.46–3.57 and IRR 1.98; 95%CI 1.94–2.01, respectively). In women, joinpoint regression showed that age-adjusted incidence of minor LEAs remained stable over time, and for major LEAs, it decreased from 2006 to 2019. In men, incidences of minor and major LEAs decreased significantly from 2004 to 2019. In-hospital mortality (IHM) increased with age and the presence of comorbidity, such as heart failure (OR 5.11; 95%CI 4.61–5.68, for minor LEAs and OR 2.91; 95%CI 2.71–3.13 for major LEAs). Being a woman was associated with higher IHM after minor and major LEA (OR 1.3; 95%CI 1.17–1.44 and OR 1.18; 95%CI 1.11–1.26, respectively). (4) Conclusions: Our data showed major sex differences indicating decreasing and increasing LEA trends among men and women, respectively; furthermore, women presented significantly higher IHM after minor and major LEA procedures than men.
Highlights
Lower-extremity amputations (LEAs) are a frequent complication suffered by people with type 2 diabetes mellitus (T2DM) and imply loss of quality of life and higher risk of short-term mortality [1]
Joinpoint regression was used to estimate incidence trends, and multivariable logistic regression to estimate factors associated with in-hospital mortality (IHM). (3) Results: LEA was coded in 129,059 patients with T2DM (27.16% in women)
We identified a total of 129,059 LEAs in patients aged ≥18 years with T2DM in Spain between 2001 and 2019
Summary
Lower-extremity amputations (LEAs) are a frequent complication suffered by people with type 2 diabetes mellitus (T2DM) and imply loss of quality of life and higher risk of short-term mortality [1]. Rates of LEAs among people with T2DM are a good indicator of the quality of diabetes care [1]. The pooled analysis of studies conducted in 21 countries suggested that the improvement in the quality of diabetes health care has contributed to a positive evolution, with a decline in major LEA rates over the last years [4]. Several studies suggest that men have higher incidence rates than women [2,3,6,7,8], but being a woman is associated with more frequent surgical site infections and a higher risk of dying in the hospital following LEAs [3,9]
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