title: Differences in minor amputation rate in diabetic foot disease throughout Europe are in part explained by differences in disease severity at presentation.
abstract: OBJECTIVE
  The incidence of minor amputation may vary significantly, and determinants of minor amputation have not been studied systematically. We evaluated minor amputation rate, the determinants of minor amputation and differences in amputation rate between European centres.
  
  
  METHODS
  In the Eurodiale study, a prospective cohort study of 1232 patients (1088 followed until end-point) with a new diabetic foot ulcer were followed on a monthly basis until healing, death, major amputation or up to a maximum of 1 year. Ulcers were treated according to international guidelines. Baseline characteristics independently associated with minor amputation were examined using multiple logistic regression modelling. Based on the results of the multivariable analysis, a disease severity score was calculated for each patient.
  
  
  RESULTS
  One hundred and ninety-four (18%) patients underwent a minor amputation. Predictors of minor amputation were depth of the ulcer (odds ratio 6.08, confidence interval 4.10-9.03), peripheral arterial disease (odds ratio 1.84, confidence interval 1.30-2.60), infection (odds ratio 1.56, confidence interval 1.05-2.30) and male sex (odds ratio 1.42, confidence interval 0.99-2.04). Minor amputation rate varied between 2.4 and 34% in the centres. Minor amputation rate in centres correlated strongly with disease severity score at the moment of presentation to the foot clinic (r=0.75).
  
  
  CONCLUSIONS
  Minor amputation is performed frequently in diabetic foot centres throughout Europe and is determined by depth of the ulcer, peripheral arterial disease, infection and male sex. There are important differences in amputation rate between the European centres, which can be explained in part by severity of disease at presentation. This may suggest that early referral to foot clinics can prevent minor amputations.
authors.affiliation: Division of Endocrinology, Department of Medicine, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht, The Netherlands. pbm01@atriummc.nl
authors.forename: P
authors.initials: P
authors.lastname: van Battum
authors.forename: N
authors.initials: N
authors.lastname: Schaper
authors.forename: L
authors.initials: L
authors.lastname: Prompers
authors.forename: J
authors.initials: J
authors.lastname: Apelqvist
authors.forename: E
authors.initials: E
authors.lastname: Jude
authors.forename: A
authors.initials: A
authors.lastname: Piaggesi
authors.forename: K
authors.initials: K
authors.lastname: Bakker
authors.forename: M
authors.initials: M
authors.lastname: Edmonds
authors.forename: P
authors.initials: P
authors.lastname: Holstein
authors.forename: A
authors.initials: A
authors.lastname: Jirkovska
authors.forename: D
authors.initials: D
authors.lastname: Mauricio
authors.forename: G
authors.initials: G
authors.lastname: Ragnarson Tennvall
authors.forename: H
authors.initials: H
authors.lastname: Reike
authors.forename: M
authors.initials: M
authors.lastname: Spraul
authors.forename: L
authors.initials: L
authors.lastname: Uccioli
authors.forename: V
authors.initials: V
authors.lastname: Urbancic
authors.forename: K
authors.initials: K
authors.lastname: van Acker
authors.forename: J
authors.initials: J
authors.lastname: van Baal
authors.forename: I
authors.initials: I
authors.lastname: Ferreira
authors.forename: M
authors.initials: M
authors.lastname: Huijberts
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D017719:Diabetic Foot / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D003929:Diabetic Neuropathies / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012720:Severity of Illness Index