Trends in lower limb amputation in the Veterans Health Administration, 1989-1998.
OBJECTIVE
To assess trends in lower limb amputation performed in Veterans Health Administration (VHA) facilities.


METHODS
All lower limb amputations recorded in the Patient Treatment File for 1989-1998 were analyzed using the hospital discharge as the unit of analysis. Age-specific rates were calculated using the VHA user-population as the denominator. Frequency tables and linear, logistic, and Poisson regression were used respectively to assess trends in amputation numbers, reoperation rates, and age-specific amputation rates.


RESULTS
Between 1989-1998, there were 60,324 discharges with amputation in VHA facilities. Over 99.9% of these were in men and constitute 10 percent of all US male amputations. The major indications were diabetes (62.9%) and peripheral vascular disease alone (23.6%). The age-specific rates of major amputation in the VHA are higher than US rates of major amputation. VHA rates of major and minor amputation declined an average of 5% each year, while the number of diabetes-associated amputations remained the same.


CONCLUSIONS
The number and age-specific rates of amputations decreased over 10 years despite an increase in the number of veterans using VHA care.
Mayfield
J A
JA
Center of Excellence in Amputation, Prosthetics, and Limb Loss Prevention, Rehabilitation Research and Development, Puget Sound Health Care System, Seattle, WA 98108, USA.
Reiber
G E
GE
Maynard
C
C
Czerniecki
J M
JM
Caps
M T
MT
Sangeorzan
B J
BJ
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends*; D003920:Diabetes Mellitus / Q000453:epidemiology; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007866:Leg / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D014728:Veterans