Lower extremity amputations in persons with and without diabetes in Italy: 2001-2010.
OBJECTIVE
To analyze hospitalization for lower extremity amputations (LEAs) and amputee rates in persons with and without diabetes in Italy.


METHODS
All patients with LEAs in the period 2001-2010 were identified analyzing the National Hospital Discharge Record database. For each year, amputee and hospitalization rates for LEAs were calculated either for persons with diabetes or without. Time trend for major and minor amputations were analysed.


RESULTS
From 2001 to 2010 a mean annual number of 11,639 individuals underwent a lower extremity amputation: 58.6% had diabetes accounting for 60.7% of total hospitalizations. In 2010, the crude amputee rate for LEAs was 20.4 per 100,000 inhabitants: 247.2 for 100.000 persons with diabetes, and 8.6 for those without diabetes. Having diabetes was associated to an increased risk of amputation (Poisson estimated RR 10.9, 95%CI 9.4-12.8). Over the whole period, a progressive reduction of amputee rates was observed for major amputations either among persons with diabetes (-30.7%) or without diabetes (-12.5%), while the rates of minor amputations increased progressively (+22.4%) among people without diabetes and were nearly stable in people with diabetes (-4.6%). A greater number of minor amputations were performed among persons with than without diabetes: in 2010, the minor-to-major ratio among persons with diabetes (2.5) was more than twice than in those without diabetes (1.0).


CONCLUSIONS
The nationwide analyses confirm a progressive reduction of hospitalization and amputee rates for major LEAs, suggesting an earlier and more diffuse approach aimed at limb salvage.
National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Roma, Italy.
Flavia L
FL
Lombardo
National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Roma, Italy.
Marina
M
Maggini
Diabetes Unit and Diabetic Foot Unit, Department of Internal Medicine General Hospital Pistoia, Pistoia, Italy.
Alessandra
A
De Bellis
Diabetes Unit and Diabetic Foot Unit, Department of Internal Medicine General Hospital Pistoia, Pistoia, Italy.
Giuseppe
G
Seghieri
Diabetes Unit and Diabetic Foot Unit, Department of Internal Medicine General Hospital Pistoia, Pistoia, Italy.
Roberto
R
Anichini
D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D017719:Diabetic Foot / Q000453:epidemiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D007558:Italy; D035002:Lower Extremity / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged