Major Amputation Rates in Patients with Peripheral Arterial Disease Aged 50 Years and Over in Denmark during the period 1997–2014 and their Relationship with Demographics, Risk Factors, and Vascular Services

Louise S. Londero*, Annette Hoegh, Kim Houlind, Jes Lindholt

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

OBJECTIVE: The aim of this nationwide study was to provide insight into the incidence and geographical distribution of vascular services and major amputations in patients with peripheral arterial disease (PAD) in Denmark.

METHODS: The incidence of major amputation caused by PAD was investigated by linking data from population based healthcare and administrative databases. The study period was divided into three parts, i.e. 1997-2002, 2003-2008, and 2009-2014. Amputation rates and revascularisation rates per 100 000 inhabitants ≥ 50 years of age were calculated and the association was displayed using scatter plots. The association between amputation rates and revascularisation rates was explored using a mixed effect model. Multivariable logistic regression was used to identify risk factors for having amputation without prior revascularisation relative to having amputation with prior revascularisation.

RESULTS: During 1997-2014, 13 075 first time major amputations were performed. The proportions of patients with diabetes as well as atherosclerotic comorbidity increased through the decades. The incidence rate decreased from 41.67 per 100 000 citizens ≥ 50 years of age in 1997-2002, to 32.53 in 2009-2014 (r = -0.88, p < .001), but with municipal differences. In parallel, revascularisations increased from 166.63 per 100 000 citizens ≥ 50 years of age in 1997-2002, to 239.05 in 2009-2014 (r = 0.83, p < .001). The percentage of patients evaluated by a vascular surgeon within a year prior to amputation increased from 23.7% to 31.3% (p < .001), while no increase in the proportion having revascularisation within a year prior to amputation was seen. Multivariable logistic regression analysis showed that diabetes mellitus (OR 1.28; CI 1.17-1.40), stroke (OR 1.66; CI 1.52-1.81), coronary heart disease (OR 1.25; CI 1.14-1.37), and renal disease (OR 1.31; CI 1.15-1.48) were associated with a higher risk of undergoing amputation without prior revascularisation.

CONCLUSIONS: The incidence of major amputations decreased, while general cardiovascular prevention and revascularisation rates increased. Despite that, few patients had revascularisation prior to amputation, leaving room for improvements.

Original languageEnglish
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume58
Issue number5
Pages (from-to)729-737
ISSN1078-5884
DOIs
Publication statusPublished - 1. Nov 2019

Fingerprint

Denmark
Incidence
Logistic Models
Comorbidity
Diabetes Mellitus
Regression Analysis
Databases
Delivery of Health Care
Kidney

Keywords

  • Major amputation
  • Major amputation rates
  • Peripheral arterial disease
  • Revascularisation rates

Cite this

@article{fc62a8d52fc44b179ed541baefa5b396,
title = "Major Amputation Rates in Patients with Peripheral Arterial Disease Aged 50 Years and Over in Denmark during the period 1997–2014 and their Relationship with Demographics, Risk Factors, and Vascular Services",
abstract = "OBJECTIVE: The aim of this nationwide study was to provide insight into the incidence and geographical distribution of vascular services and major amputations in patients with peripheral arterial disease (PAD) in Denmark.METHODS: The incidence of major amputation caused by PAD was investigated by linking data from population based healthcare and administrative databases. The study period was divided into three parts, i.e. 1997-2002, 2003-2008, and 2009-2014. Amputation rates and revascularisation rates per 100 000 inhabitants ≥ 50 years of age were calculated and the association was displayed using scatter plots. The association between amputation rates and revascularisation rates was explored using a mixed effect model. Multivariable logistic regression was used to identify risk factors for having amputation without prior revascularisation relative to having amputation with prior revascularisation.RESULTS: During 1997-2014, 13 075 first time major amputations were performed. The proportions of patients with diabetes as well as atherosclerotic comorbidity increased through the decades. The incidence rate decreased from 41.67 per 100 000 citizens ≥ 50 years of age in 1997-2002, to 32.53 in 2009-2014 (r = -0.88, p < .001), but with municipal differences. In parallel, revascularisations increased from 166.63 per 100 000 citizens ≥ 50 years of age in 1997-2002, to 239.05 in 2009-2014 (r = 0.83, p < .001). The percentage of patients evaluated by a vascular surgeon within a year prior to amputation increased from 23.7{\%} to 31.3{\%} (p < .001), while no increase in the proportion having revascularisation within a year prior to amputation was seen. Multivariable logistic regression analysis showed that diabetes mellitus (OR 1.28; CI 1.17-1.40), stroke (OR 1.66; CI 1.52-1.81), coronary heart disease (OR 1.25; CI 1.14-1.37), and renal disease (OR 1.31; CI 1.15-1.48) were associated with a higher risk of undergoing amputation without prior revascularisation.CONCLUSIONS: The incidence of major amputations decreased, while general cardiovascular prevention and revascularisation rates increased. Despite that, few patients had revascularisation prior to amputation, leaving room for improvements.",
keywords = "Major amputation, Major amputation rates, Peripheral arterial disease, Revascularisation rates",
author = "Londero, {Louise S.} and Annette Hoegh and Kim Houlind and Jes Lindholt",
year = "2019",
month = "11",
day = "1",
doi = "10.1016/j.ejvs.2019.06.007",
language = "English",
volume = "58",
pages = "729--737",
journal = "European Journal of Vascular and Endovascular Surgery",
issn = "1078-5884",
publisher = "Elsevier",
number = "5",

}

TY - JOUR

T1 - Major Amputation Rates in Patients with Peripheral Arterial Disease Aged 50 Years and Over in Denmark during the period 1997–2014 and their Relationship with Demographics, Risk Factors, and Vascular Services

AU - Londero, Louise S.

AU - Hoegh, Annette

AU - Houlind, Kim

AU - Lindholt, Jes

PY - 2019/11/1

Y1 - 2019/11/1

N2 - OBJECTIVE: The aim of this nationwide study was to provide insight into the incidence and geographical distribution of vascular services and major amputations in patients with peripheral arterial disease (PAD) in Denmark.METHODS: The incidence of major amputation caused by PAD was investigated by linking data from population based healthcare and administrative databases. The study period was divided into three parts, i.e. 1997-2002, 2003-2008, and 2009-2014. Amputation rates and revascularisation rates per 100 000 inhabitants ≥ 50 years of age were calculated and the association was displayed using scatter plots. The association between amputation rates and revascularisation rates was explored using a mixed effect model. Multivariable logistic regression was used to identify risk factors for having amputation without prior revascularisation relative to having amputation with prior revascularisation.RESULTS: During 1997-2014, 13 075 first time major amputations were performed. The proportions of patients with diabetes as well as atherosclerotic comorbidity increased through the decades. The incidence rate decreased from 41.67 per 100 000 citizens ≥ 50 years of age in 1997-2002, to 32.53 in 2009-2014 (r = -0.88, p < .001), but with municipal differences. In parallel, revascularisations increased from 166.63 per 100 000 citizens ≥ 50 years of age in 1997-2002, to 239.05 in 2009-2014 (r = 0.83, p < .001). The percentage of patients evaluated by a vascular surgeon within a year prior to amputation increased from 23.7% to 31.3% (p < .001), while no increase in the proportion having revascularisation within a year prior to amputation was seen. Multivariable logistic regression analysis showed that diabetes mellitus (OR 1.28; CI 1.17-1.40), stroke (OR 1.66; CI 1.52-1.81), coronary heart disease (OR 1.25; CI 1.14-1.37), and renal disease (OR 1.31; CI 1.15-1.48) were associated with a higher risk of undergoing amputation without prior revascularisation.CONCLUSIONS: The incidence of major amputations decreased, while general cardiovascular prevention and revascularisation rates increased. Despite that, few patients had revascularisation prior to amputation, leaving room for improvements.

AB - OBJECTIVE: The aim of this nationwide study was to provide insight into the incidence and geographical distribution of vascular services and major amputations in patients with peripheral arterial disease (PAD) in Denmark.METHODS: The incidence of major amputation caused by PAD was investigated by linking data from population based healthcare and administrative databases. The study period was divided into three parts, i.e. 1997-2002, 2003-2008, and 2009-2014. Amputation rates and revascularisation rates per 100 000 inhabitants ≥ 50 years of age were calculated and the association was displayed using scatter plots. The association between amputation rates and revascularisation rates was explored using a mixed effect model. Multivariable logistic regression was used to identify risk factors for having amputation without prior revascularisation relative to having amputation with prior revascularisation.RESULTS: During 1997-2014, 13 075 first time major amputations were performed. The proportions of patients with diabetes as well as atherosclerotic comorbidity increased through the decades. The incidence rate decreased from 41.67 per 100 000 citizens ≥ 50 years of age in 1997-2002, to 32.53 in 2009-2014 (r = -0.88, p < .001), but with municipal differences. In parallel, revascularisations increased from 166.63 per 100 000 citizens ≥ 50 years of age in 1997-2002, to 239.05 in 2009-2014 (r = 0.83, p < .001). The percentage of patients evaluated by a vascular surgeon within a year prior to amputation increased from 23.7% to 31.3% (p < .001), while no increase in the proportion having revascularisation within a year prior to amputation was seen. Multivariable logistic regression analysis showed that diabetes mellitus (OR 1.28; CI 1.17-1.40), stroke (OR 1.66; CI 1.52-1.81), coronary heart disease (OR 1.25; CI 1.14-1.37), and renal disease (OR 1.31; CI 1.15-1.48) were associated with a higher risk of undergoing amputation without prior revascularisation.CONCLUSIONS: The incidence of major amputations decreased, while general cardiovascular prevention and revascularisation rates increased. Despite that, few patients had revascularisation prior to amputation, leaving room for improvements.

KW - Major amputation

KW - Major amputation rates

KW - Peripheral arterial disease

KW - Revascularisation rates

U2 - 10.1016/j.ejvs.2019.06.007

DO - 10.1016/j.ejvs.2019.06.007

M3 - Journal article

VL - 58

SP - 729

EP - 737

JO - European Journal of Vascular and Endovascular Surgery

JF - European Journal of Vascular and Endovascular Surgery

SN - 1078-5884

IS - 5

ER -