Amputation Risk in Patients with Diabetes Mellitus and Peripheral Artery Disease Using Statewide Data - PubMed (original) (raw)

Amputation Risk in Patients with Diabetes Mellitus and Peripheral Artery Disease Using Statewide Data

Misty D Humphries et al. Ann Vasc Surg. 2016 Jan.

Abstract

Background: Conflicting data exist regarding changes in amputation rates in patients with ulcers because of diabetes mellitus (DM) and peripheral artery disease (PAD). This study focuses on how population-based amputation rates are changing in the current treatment era.

Methods: Using the California Office of Statewide Health Planning and Development Patient Discharge database, all patients who underwent major nontraumatic lower extremity (LE) amputation in 2005 through 2011 were identified. Age-adjusted population-based amputation risk was determined by year. Gender and age trends in amputation risk were estimated separately for diabetes-related amputations and PAD-related amputations, treating all California residents as the population at risk.

Results: From 2005 to 2011, 32,025 qualifying amputations were performed in California. Of these, 11,896 were DM-associated (n = 1,095), PAD-associated (n = 4,335), or associated with both conditions (n = 6,466). PAD-associated amputation rates and combined PAD/DM-associated amputation rates have changed little since 2009 after decreasing substantially over the prior 5 years, but DM-associated amputation rates have continuously increased since 2005. California residents older than the age of 80 years had the most dramatic decrease in PAD-associated amputation rates from 2005 to 2011 (i.e., from 317 to 175 per million Californians). Men with PAD/DM had amputation rate 1.5 times higher than those of patients with PAD alone and 5 times higher than rates of DM patients. In women the difference between patient with PAD and PAD/DM was not seen; however, these rates were 2.5 times higher than patients with DM alone.

Conclusions: Preventable amputations associated with high-risk diseases are no longer decreasing despite continuing advances in care and education. Octogenarians with PAD represent the highest risk group for amputation, but DM-associated amputations have increased since 2005. Further research to understand treatment pathways for patient with LE wounds may shed light on pathways for amputation prevention in the future.

Copyright © 2016 Elsevier Inc. All rights reserved.

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Figures

Fig. 1

Fig. 1

Flow diagram for selection of patients the diseases of PAD, DM, and combination disease of PAD and DM.

Fig. 2

Fig. 2

Age-adjusted amputation rates/1 million Californians older than the age of 18 years for patients with PAD, DM, and combined PAD and DM.

Fig. 3

Fig. 3

Age-divided amputation rates/1 million Californians of the same age group for patients with (A) PAD, (B) DM, and (C) combined PAD and DM. (A) PAD patients only. (B) DM patients only (Scale in patients with DM has been adjusted because of the low numbers to allow visualization of the groups). (C) Patients with PAD/DM.

Fig. 4

Fig. 4

Amputation rates/1 millions Californians of the same gender for men (A) and women (B) with PAD, DM, and combined PAD & DM. (A) Men. (B) Women.

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