The national hospital discharge register data on lower limb amputations.
OBJECTIVE
To study if data on lower limb amputations and vascular operations in the National Hospital Discharge Register can be used for comparison of diabetes care between hospital districts.


METHODS
We identified diabetic persons from the National Hospital Discharge Register (1988-2002), the National Social Security Institute (since 1964) and pharmacies (since 1994). A search for lower limb amputations and vascular operations was made through the Hospital Discharge Register. An analysis of the correlation of the age and gender adjusted incidence of first major amputations and the age and gender adjusted incidence of first vascular operations for diabetics was made between 14 hospitals districts with the largest diabetic population.


RESULTS
A total of 308,447 diabetics were identified. There were 11,070 diabetics who had a lower extremity amputation and 9530 diabetics who had a vascular operation in Finland in 1988-2002. The annual number of first amputations decreased from 924 to 387 per 100,000 diabetics during the study period. There were up to three-fold differences in age and gender adjusted indexed numbers of first amputations between different hospital districts during the last follow-up period from year 2000 to 2002. There was a clear inverse correlation between the incidence of first major amputations and first vascular operations and particularly between incidence of first major amputations and infrapopliteal reconstructions.


CONCLUSIONS
The incidence of major amputation is declining in the diabetic population. This positive development can be explained by more active vascular operative treatment. Regional differences are wider than acceptable.
Winell
K
K
Finnish Diabetes Association, Espoo, Finland. klas.winell@conmedic.fi
Niemi
M
M
Lepantalo
M
M
D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D017719:Diabetic Foot / Q000517:prevention & control / Q000601:surgery*; D005260:Female; D005387:Finland; D006767:Hospitals, District / Q000706:statistics & numerical data*; D006801:Humans; D023821:Limb Salvage / Q000706:statistics & numerical data*; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D010351:Patient Discharge; D010818:Practice Patterns, Physicians'; D012042:Registries; D012189:Retrospective Studies