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Abstract
Objectives Patients with non-traumatic lower extremity amputation are characterised by high age, multi-morbidity and polypharmacy and long-term complications of atherosclerosis and diabetes. To ensure early identification of patients at risk of amputation, we need to gain knowledge about the progression of diseases related to lower extremity amputations during the years preceding the amputation.
Design A retrospective population-based national registry study.
Setting The study includes data on demographics, diagnoses, surgery, medications and healthcare services from five national registries. Data were retrieved from 14 years before until 1 year after the amputation. Descriptive statistics were used to describe the progression of diseases and use of medication and healthcare services.
Participants An unselected cohort of patients (≥50 years; n=2883) subjected to a primary non-traumatic lower extremity amputation in 2010 or 2011 in Denmark.
Results The prevalence of atherosclerosis, hypertension and diabetes was 70%, 53% and 49%, respectively. Among patients with atherosclerosis, 42% had not received cholesterol-lowering treatment even though 87% had visited their general practitioner within the last year prior to amputation. Further, 16% were diagnosed with diabetes at the time of the amputation. The prevalence of cardiovascular diseases increased from 22% to 70%, atherosclerosis from 5% to 53% and diabetes from 17% to 35% over the 14 years preceding major amputation. Of all patients, 64% had been in contact with the hospital or outpatient clinics within the last 3 years, and 29% received a prescription of opioids 3 years prior to the amputation.
Conclusion Among patients with non-traumatic lower extremity amputation, one-third live with undiagnosed and untreated atherosclerosis and one-sixth suffer from undiagnosed diabetes despite continuous contacts to general practitioner and the hospital. This study emphasises a need for enhanced focus, among both hospital clinicians and general practitioners, on the early identification of atherosclerosis and diabetes.
- lower extremity amputation
- atherosclerosis
- diabetes
- healthcare services
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Footnotes
Contributors SJ and JP describe the study. PSJ and OA ensured funding. PSJ, JP, KKM, IP and OA designed the study. PSJ and JP applied for data at Statistics Denmark. PSJ and JP provided the statistical expertise. IP, KKM and OA provided the clinical and medical expertise. PSJ and JP performed the data management and analysis. All authors helped interpret the data. The accuracy of data and analysis was reviewed by all authors who can take responsibility for the integrity of the data and the accuracy of the data analysis. PSJ drafted the manuscript. All authors reviewed and critically revised the manuscript for intellectual content and approved the final version of the manuscript.
Funding This study was funded by the Novo Nordic Foundation grant number NNF12OC0002017 and Copenhagen University Hospital, Hvidovre Research Foundation. None of the sponsors were involved in the design of the study, collection, analysis, interpretation of data and in writing the manuscript.
Competing interests None declared.
Patient consent The study only used anonymised data from national registries.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The datasets supporting the conclusions of this article are available in the Statistics Denmark, http://www.dst.dk/. Statistics Denmark managed and provided the secured access In according to Danish regulations; data are available by applying Statistics Denmark.