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. 2014 Jan 28;9(1):e86405.
doi: 10.1371/journal.pone.0086405. eCollection 2014.

Lower extremity amputations in persons with and without diabetes in Italy: 2001-2010

Flavia L Lombardo  1 , Marina Maggini  1 , Alessandra De Bellis  2 , Giuseppe Seghieri  2 , Roberto Anichini  2
Affiliations

Lower extremity amputations in persons with and without diabetes in Italy: 2001-2010

Flavia L Lombardo et al. PLoS One. .

Abstract

Objective: To analyze hospitalization for lower extremity amputations (LEAs) and amputee rates in persons with and without diabetes in Italy.

Research design and methods: All patients with LEAs in the period 2001-2010 were identified analyzing the National Hospital Discharge Record database. For each year, amputee and hospitalization rates for LEAs were calculated either for persons with diabetes or without. Time trend for major and minor amputations were analysed.

Results: From 2001 to 2010 a mean annual number of 11,639 individuals underwent a lower extremity amputation: 58.6% had diabetes accounting for 60.7% of total hospitalizations. In 2010, the crude amputee rate for LEAs was 20.4 per 100,000 inhabitants: 247.2 for 100.000 persons with diabetes, and 8.6 for those without diabetes. Having diabetes was associated to an increased risk of amputation (Poisson estimated RR 10.9, 95%CI 9.4-12.8). Over the whole period, a progressive reduction of amputee rates was observed for major amputations either among persons with diabetes (-30.7%) or without diabetes (-12.5%), while the rates of minor amputations increased progressively (+22.4%) among people without diabetes and were nearly stable in people with diabetes (-4.6%). A greater number of minor amputations were performed among persons with than without diabetes: in 2010, the minor-to-major ratio among persons with diabetes (2.5) was more than twice than in those without diabetes (1.0).

Conclusions: The nationwide analyses confirm a progressive reduction of hospitalization and amputee rates for major LEAs, suggesting an earlier and more diffuse approach aimed at limb salvage.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Age and sex standardized amputee and hospitalization rates in persons (a) with and (b) without diabetes. Italy, 2001–2010.
Figure 2
Figure 2. Amputee rate by sex and age classes (major, minor and total amputations) in people with diabetes. Italy, 2010.
See this image and copyright information in PMC

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