Dementia and amputation

Abstract

Objectives: To our experience dementia seems to play an increasing role for major amputation in patients suffering from peripheral arterial disease (PAD). To confirm our impression, we analysed the rate of dementia associated with different surgical procedures using the information of the federal statistics in Germany.

Patients and methods: Detailed lists of cases hospitalized with the principal diagnosis (PAD), abdominal aortic aneurysm (AAA), myocardial infarction (MI) and hip fracture (HF), and of the procedures minor or major amputation, endovascular aortic repair (EVAR), total endoprosthesis for hip replacement (THR) and coronary aortic bypass graft (CABG) in Germany in the years 2008 to 2010 were provided by the Federal Statistical Office.

Results: Dementia is documented as additional diagnosis in approximately one fourth of cases having the principal diagnosis HF, 5% to 6% of cases with the principal diagnosis MI and PAD, but only in approximately 2% of AAA cases. Dementia is documented as principal or additional diagnosis in one fourth of amputation procedures (major amputation approximately 18% and minor amputation approximately 8%), in approximately 5% THR, 2% of EVAR and only 0.3% of CABG. The rate of documentation of dementia is higher in patients treated by major amputation than in the hospitalized PAD population. Vice versa, the rate of documentation of dementia is lower in patients getting THR than in the hospitalized HF population.

Conclusion: The presented analysis supports the assumption that dementia plays a relevant role in older patients suffering from PAD receiving major amputation in Germany.

Keywords: DRG statistics; abdominal aortic aneurysm amputation; endovascular aortic repair; hip fracture; peripheral arterial disease; total hip replacement.

Fig. 1.

Age dependency of the rate of dementia documented as secondary diagnosis in cases with the principal diagnosis peripheral arterial disease (PAD), abdominal aortic aneurysm (AAA), myocardial infarction (MI) and hip fracture (HF) in Germany in the years 2008 to 2010 (continuous line is 2010, dotted lines are 2008 and 2009)

Fig. 2.

Age dependency of the rate of dementia documented as principal or secondary diagnosis in patients with one of the following procedures: minor or major amputation, endovascular aortic repair (EVAR), total hip replacement (THR) or coronary aortic bypass graft (CABG) in Germany in the years 2008 to 2010 (continuous line is 2010, dotted lines are 2008 and 2009)