title: Trends in lower limb amputation in the Veterans Health Administration, 1989-1998.
abstract: 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.
authors.affiliation: Center of Excellence in Amputation, Prosthetics, and Limb Loss Prevention, Rehabilitation Research and Development, Puget Sound Health Care System, Seattle, WA 98108, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Mayfield
authors.forename: G E
authors.initials: GE
authors.lastname: Reiber
authors.forename: C
authors.initials: C
authors.lastname: Maynard
authors.forename: J M
authors.initials: JM
authors.lastname: Czerniecki
authors.forename: M T
authors.initials: MT
authors.lastname: Caps
authors.forename: B J
authors.initials: BJ
authors.lastname: Sangeorzan
mesh_terms: 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