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. 2022 Jun 8:17:925-936.
doi: 10.2147/CIA.S361547. eCollection 2022.

Major Lower Limb Amputations and Amputees in an Aging Population in Southwest Finland 2007-2017

Veerakaisa Koivunen  1 , Vaiva Dabravolskaite  1   2 , Veikko Nikulainen  1   2 , Markus Juonala  1   3 , Päivi Helmiö  1   2 , Harri Hakovirta  1   2   4
Affiliations

Major Lower Limb Amputations and Amputees in an Aging Population in Southwest Finland 2007-2017

Veerakaisa Koivunen et al. Clin Interv Aging. .

Abstract

Purpose: The aim of the present study was to describe and analyze changes in the incidences of lower extremity amputations (LEAs), patient characteristics, vascular history of amputees and survival in Southwest Finland.

Patients and methods: This is a retrospective patient study in the Hospital District of Southwest Finland. All consecutive patients with atherosclerosis and diabetes-caused LEA, between 1st January 2007 and 31st December 2017, were included. The annual incidences of major LEA patients were statistically standardized. Patients' diagnoses, functional status, previous revascularizations and minor amputations were recorded, and survival was analyzed.

Results: During the 11-year-period major LEAs were performed on 891 patients, 118 (13.2%) were urgent operations. The overall incidence of major LEA was 17.2/100 000 and was age-dependent (3.1 for ≤64 years, 34.3 for 65-74 years, 81.5 for 75-84 years, 216 for ≥85 years). A decrease in incidence was detected in the <65 year-age-group (incidence 4.98 in 2007 and 1.88 in 2017; p = 0.0018). Among older age groups, there was no significant change. Half (50.6%) of all amputees were diabetics. Altogether, 472 patients (53.0%) had a history of revascularization before LEA. 80.1% of index amputations were transfemoral and 19.9% transtibial. Re-surgery was performed on 94 (10.5%) patients. The 1-, 3- and 5-year overall survival were 56%, 30%, and 18%, respectively.

Conclusion: Our results suggest that in an aging population, despite good availability of vascular services, a significant number of patients are not fit for active revascularization, and LEA is the only feasible treatment for critical limb ischemia.

Keywords: aging; diabetes; major amputation; peripheral artery disease.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
The annual population and age structure in the Hospital district of Southwest Finland 2007–2017 according to Official Statistics of Finland. Panel (A) total population and population aged ≤64 years. Panel (B) Population 65–74 years, 75–84 years and ≥85 years old.
Figure 2
Figure 2
History of revascularizations before major LEA of 891 amputees at the index major LEA by age group in the Hospital District of Southwest Finland 2007–2017. NREV patients without history of revascularization before the major LEA; REV patients with history of revascularization before the major LEA.
Figure 3
Figure 3
Age-dependent 3-year survival after the index major amputation. The number of patients entering each 12-month interval is indicated on horizontal axis. The Hospital District of Southwest Finland 2007–2017.
See this image and copyright information in PMC

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