Lower-limb amputation rate remains constant during 6-year period

The rate of lower-limb amputations performed in Germany remained relatively constant between 2006 and 2012, according to results of a population-based study.

The findings contradict those from earlier studies indicating a decline in the amputation rate and indicate a need for further preventive action, both within the general population and among specific patient subgroups, the researchers wrote.

The study incorporated data on endovascular lower-limb amputations conducted between 2006 and 2012 among 4 million patients with health insurance from 80 different providers in Germany. Prevalence of lower-limb amputation was assessed for the general population and among those with diabetes and arterial occlusive disease specifically.

During the evaluated period, the standardized amputation rate within the general population remained constant at 0.04%. However, the researchers noted that amputation frequency increased by 51%, from 1,893 procedures in 2006 to 2,874 in 2012. The 2012 amputations were performed in 1,625 patients, for a rate of 41 patients per 100,000 insurants requiring one or more amputations. Extrapolation to the entire German population yielded 49,150 lower-limb amputations performed in 32,767 patients, 78% of which occurred in patients with diabetes or arterial occlusive disease.

Approximately 70% of the amputations performed were minor, or only involved the removal of a toe; the remaining procedures included major amputations, in which part of the leg was amputated, or both minor and major amputations.

Analysis of patients with diabetes and arterial occlusive disease indicated a slight decrease in the per-patient amputation rate, despite an increase in the prevalence of diabetes from 7.87% in 2006 to 8.69% in 2012. Arterial occlusive disease prevalence also increased during the evaluated period, from 0.13% to 0.24%, the researchers wrote.

“From 2006 to 2012, the overall amputation rate in the population has remained unchanged,” the researchers wrote. They added that their findings contradicted those from prior studies indicating a change to the amputation rate over time, as well as a trend toward increasing rates of minor amputations and decreasing major amputation rates, which “could not be confirmed” in this analysis. However, the researchers acknowledged differences between health insurance companies and the potential for undiagnosed or misclassified diabetes or arterial occlusive disease as possible limitations, and that the use of data from different sources to prior studies limits the ability to compare the findings.

“As patients with amputations have an impaired quality of life and an increased mortality, further preventive action is needed in Germany in order to decrease the number of amputations of lower limbs in the entire population and those with diabetes or [arterial occlusive disease] in the future,” they wrote. “Additional studies on barriers to guideline adherence to treatment of patients at risk [for] amputation are necessary to optimize the prevention of amputations.” – by Adam Taliercio

Disclosure: The researchers report no relevant financial disclosures.

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