Reduction in Diabetes-Related Lower-Extremity Amputations in the Netherlands: 1991–2000

  1. William H. van Houtum, MD, PHD1,
  2. Jan A. Rauwerda, MD, PHD2,
  3. Dirk Ruwaard, PHD3,
  4. Nicolaas C. Schaper, MD, PHD4 and
  5. Karel Bakker, MD, PHD5
  1. 1Department of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
  2. 2Department of Vascular Surgery, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
  3. 3National Institute for Public Health and the Environment, Public Health Division, Bilthoven, the Netherlands
  4. 4Department of Internal Medicine, Academical Hospital Maastricht, Maastricht, the Netherlands
  5. 5International Diabetes Federation Consultative Section on the Diabetic Foot, Heemstede, the Netherlands
  1. Address correspondence and reprint requests to William H. van Houtum, Leiden University Medical Center, Department of Endocrinology, P.O. Box 9600, 2300 RC, Leiden, Netherlands. E-mail: houtum{at}tiscali.nl

Abstract

OBJECTIVE—Lower-extremity amputation is a common complication among patients with diabetes throughout the world. However, few data exist on the actual impact of the recent moves to improve the management of diabetic foot ulcers to reduce the incidence of lower-extremity amputations. The aim was to determine the incidence of lower-extremity amputations among diabetic patients from 1991 to 2000 in the Netherlands.

RESEARCH DESIGN AND METHODS—A secondary database containing information regarding all hospital admissions in which a lower-extremity amputation occurred for the years 1991–2000 was obtained from the Dutch National Medical Register. Because a patient-unique identifier was included, multiple amputations and hospitalizations for a single individual could be identified. Furthermore, age- and sex-specific diabetes prevalence rates were calculated using a 3-year average for every year, calculating the total diabetic population in the Netherlands at risk for every year.

RESULTS—In 1991, a total of 1,687 patients with diabetes had been admitted 1,865 times for 2,409 amputations. In 2000, a total of 1,673 patients with diabetes were admitted 1,932 times for 2,448 amputations. The overall incidence rates of the number of patients who underwent lower-extremity amputation decreased over the years from 55.0 to 36.3 per 10,000 patients with diabetes (P < 0.05). Both in men (71.8 vs. 46.1, P < 0.05) and women (45.0 vs. 28.0, P < 0.05) with diabetes, a significant decrease could be observed. Mean duration of hospitalization decreased from 45.0 days (SD 44.4) in 1991 to 36.2 days (SD 38.4) in 2000; decreases were observed for both men and women.

CONCLUSIONS—Over the years observed in this study, the incidence rates of diabetes-related lower-extremity amputation in the Netherlands was found to decrease in both men (36%) and women (38%) with diabetes. Furthermore, the duration of hospitalization decreased over time.

Footnotes

    • Accepted January 26, 2004.
    • Received November 11, 2003.
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  1. doi: 10.2337/diacare.27.5.1042 Diabetes Care May 2004 vol. 27 no. 5 1042-1046
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