title: The impact of diabetes-related lower-extremity amputations in The Netherlands.
abstract: The purpose of this study is to identify the incidence of diabetes-related lower-extremity amputations in the Netherlands. We used discharge records from SIG Health Care Information for every hospitalization for a lower-extremity amputation in all hospitals in the Netherlands in 1992. Age- and gender-specific population figures and diagnosed cases of diabetes were obtained from the Central Bureau of Statistics. Age- and gender-adjusted amputation incidences were identified at four different levels (toe, foot, leg, and thigh). Multiple amputations were analyzed by the highest level. Of all lower-extremity amputations, 1,575 (47%) were in persons with diabetes mellitus. Age- and gender-adjusted lower-extremity amputation rates per 10,000 persons with diabetes by level were the following: toe 12.39, foot 2.42, leg 7.82, thigh 2.54, and total 25.17. People with diabetes were 20.3 times more likely to experience a lower-extremity amputation than people without diabetes. Males were at a significantly higher risk of experiencing an amputation than females. There was a significant increase in the age-specific incidence of amputations as age increased. The most common amputation procedure performed was the toe amputation. There was a significant increase in thigh amputations as age increased, indicating that as people get older they suffer higher levels of amputations. Although the incidence of lower-extremity amputations was lower than previous reports, they still have a serious impact on the health-care system in the Netherlands.
authors.affiliation: Mexican American Medical Treatment Effectiveness Research Center, University of Texas Health Science Center at San Antonio 78284-7776, USA.
authors.forename: W H
authors.initials: WH
authors.lastname: van Houtum
authors.forename: L A
authors.initials: LA
authors.lastname: Lavery
authors.forename: L B
authors.initials: LB
authors.lastname: Harkless
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D017719:Diabetic Foot / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005528:Foot; D006801:Humans; D015994:Incidence; D007866:Leg; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D018570:Risk Assessment; D012727:Sex Characteristics; D012737:Sex Factors; D013848:Thigh; D014034:Toes