title: Epidemiological study of lower limb amputation in England between 2003 and 2008.
abstract: BACKGROUND
  The purpose of this study was to investigate the prevalence of lower extremity amputation in England, to establish the associated mortality, and to determine the relationship with diabetes mellitus and previous revascularization.
  
  
  METHODS
  Data on all patients who had a lower extremity amputation between 2003 and 2008 were extracted from the Hospital Episode Statistics database. Risk adjustment and linear regression were used to compare the data.
  
  
  RESULTS
  The major amputation rate was 5.1 per 100,000 population and did not change over the 5 years. The mortality rate for major leg amputation was 16.8 per cent (21.4 per cent for above-knee and 11.6 per cent for below-knee amputation); this decreased significantly over time (P < 0.001). There was a significant difference in amputation rate, mortality rate and the below-knee : above-knee amputation ratio between different areas of England (P < 0.001). Some 39.4 per cent of patients who underwent major amputation had diabetes mellitus. The odds of revascularization before amputation increased significantly over time (P = 0.035).
  
  
  CONCLUSIONS
  Major and minor amputation rates were stable across England between 2003 and 2008, accompanied by a significant reduction in perioperative mortality. There were significant geographical variations in amputation rates, mortality rates and the below-knee : above-knee amputation ratio.
authors.affiliation: Department of Outcomes Research, St George's Vascular Institute, St George's Healthcare NHS Trust, London, UK. paul.moxey@nhs.net
authors.forename: P W
authors.initials: PW
authors.lastname: Moxey
authors.forename: D
authors.initials: D
authors.lastname: Hofman
authors.forename: R J
authors.initials: RJ
authors.lastname: Hinchliffe
authors.forename: K
authors.initials: K
authors.lastname: Jones
authors.forename: M M
authors.initials: MM
authors.lastname: Thompson
authors.forename: P J E
authors.initials: PJ
authors.lastname: Holt
mesh_terms: D000671:Amputation, Surgical / Q000401:mortality / Q000706:statistics & numerical data*; D019917:Blood Vessel Prosthesis Implantation / Q000401:mortality / Q000706:statistics & numerical data; D003925:Diabetic Angiopathies / Q000401:mortality / Q000601:surgery; D004739:England / Q000453:epidemiology; D005528:Foot / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007866:Leg / Q000601:surgery*; D020379:Risk Adjustment