The Evolution of Amputation in the Province of Quebec

• Published in: Canadian journal of diabetes Vol. 34; no. 1; pp. 58 - 66
• Main Authors: Dawes, Diana, MSc, Iqbal, Sameena, MD, Steinmetz, Oren K., MD, Mayo, Nancy, PhD
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 2010
• Subjects: amputation; comorbidity; diabetes; diabÉte; Endocrinology & Metabolism; Other; troubles comorbides; amputation; comorbidity; diabetes; troubles comorbides; diabÉte
• ISSN: 1499-2671; 2352-3840
• DOI: 10.1016/S1499-2671(10)41011-4

ABSTRACT OBJECTIVE: Lower-extremity amputation rate is often used as an indicator of the quality of diabetes care. This study provides a long-term perspective on amputation in the Quebec population, estimating changes over time in rates of vascular amputation and comorbidity profile. METHODS: A population-based admission-to-discharge cohort study was conducted using hospital discharge data. The population consisted of all Quebec residents having an amputation from January 1, 1996, to December 31, 2004. The reason for amputation was defined by diagnostic code; the level of amputation was identified by treatment code; and the proportion of people with specific comorbidities was calculated for each year. Age-and sex-specific rates of amputation were calculated. RESULTS: A total of 10 834 people had 15 992 amputations. Of these people, 79% had vascular disease. Within this population, hypertension has increased by 27.2% (95% CI 22.9-31.6), renal disease by 14.9% (95% CI 11.1-18.7) and ischemic heart disease by 20.4% (95% CI 16.3-24.4). Length of hospital stay did not change over time; the median length of stay was 20 days (IQR: 8.5, 40, 658). Women having foot amputations, people having multiple amputations or people with a high Charlson index score were more likely to stay in hospital for more than 28 days. A linear decrease in the rate of vascular and diabetic amputations was observed for both men and women, with the greatest decrease being 8.1% (95% CI 5.8-10.4) among males with vascular disease. INTERPRETATION: Despite the decline in sex-specific, agestandardized rates of amputation, there was no decrease in the number of amputations being performed; this may reflect the increased prevalence of diabetes and standard of care being given. The implication for the changing profile of people having amputations are great: for example, post-amputation care needs to address the multiple comorbidities.