Incidence rates of dysvascular lower extremity amputation changes in Northern Netherlands: A comparison of three cohorts of 1991-1992, 2003-2004 and 2012-2013

ObjectiveTo analyze the incidence rates of dysvascular major lower extremity amputations (LEA) in Northern Netherlands in 2012–2013 compared to previous cohorts in 1991–1992 and 2003–2004.DesignRetrospective cohort study.ParticipantsAdults (N = 343) with first ever dysvascular LEA at ankle disarticulation or more proximal levels. The median age (interquartile range) was 74.2 years (64.5–81.9), 64% were male and 55% had been diagnosed with diabetes mellitus (DM).Main outcome measuresCrude and age-standardized incidence rates of major LEA per 100.000 person-years.ResultsCrude incidence rate (IR) of first ever major LEA in 2012–2013 was 9.9 per 100.000 person-years, while the age-standardized IR was 7.7 per 100.000 person-years. A Poisson regression analysis showed that amputation rates among men were 2.3 times higher compared to women (95%CI 1.9–2.6), while in 2012–2013 the population aged >63 years had decreased amputation rates compared to 1991–1992. In the DM population the crude IR decreased from 142.6 per 100.000 person-years in 2003–2004 to 89.2 per 100.000 person-years in 2012–2013 (pConclusionsIn 2012–2013 a decrease in age-standardized IR for the general population and a decrease in crude IR for the DM population were observed compared to cohorts from the previous two decades, despite considerable shifts in the age distribution of the Dutch population towards more elderly people and increased prevalence of DM. These findings might suggest that improved treatment of patients at risk of dysvascular amputations is associated with reduced incidence rates of major LEA at the population level.研究目的：本研究旨在分析2012-2013年荷兰北部血管异常性重大下肢截肢（lower extremity amputation, LEA）的发病率，并与1991-1992年及2003-2004年的既往队列进行对比。研究设计：回顾性队列研究。研究对象：因首次行踝关节离断术或更高平面截肢的成年患者（N=343）。其中位年龄（四分位间距）为74.2岁（64.5~81.9岁），男性占比64%，55%的患者确诊为糖尿病（Diabetes Mellitus, DM）。主要结局指标：每10万人年的粗发病率与年龄标化重大下肢截肢发病率。研究结果：2012-2013年首次重大下肢截肢的粗发病率为9.9/10万人年，年龄标化发病率为7.7/10万人年。泊松回归分析显示，男性截肢率较女性高2.3倍（95%置信区间：1.9~2.6）；与1991-1992年队列相比，2012-2013年中年龄＞63岁人群的截肢率有所下降。在糖尿病患者群体中，粗发病率从2003-2004年的142.6/10万人年降至2012-2013年的89.2/10万人年（p）。研究结论：与前两个十年的队列相比，2012-2013年荷兰普通人群的年龄标化发病率及糖尿病患者群体的粗发病率均有所下降，尽管荷兰人口年龄结构向老龄化方向发生了显著转变，且糖尿病患病率有所升高。本研究结果提示，针对血管异常性截肢高危患者的优化治疗，与人群层面重大下肢截肢发病率的降低存在关联。