title: Trends in Major Lower Limb Amputation Related to Peripheral Arterial Disease in Hungary: A Nationwide Study (2004-2012).
abstract: OBJECTIVE
  To assess the trends of peripheral arterial disease associated major lower limb amputation in Hungary over a 9 year period (2004-2012) in the whole Hungarian population.
  
  
  METHODS
  This was a retrospective cohort study employing administrative health care data. Major amputations were identified in the entire Hungarian population during a 9 year period (2004-2012) using the health care administrative data. Direct standardization was used to eliminate the potential bias induced by the different age and sex structure of the compared populations. For external direct standardization, the ESP 2013 was chosen as reference.
  
  
  RESULTS
  76,798 lower limb amputations were performed. The number of major amputations was 38,200; these procedures affected 32,084 patients. According to case detection, 50.4% of the amputees were diabetic. The overall primary amputation rate was 71.5%. The annual crude and age adjusted major amputation rates exhibited no significant long-term pattern over the observation period. The major lower limb amputation incidence for the overall period was 42.3/10(5) in the total population and 317.9/10(5) in diabetic population.
  
  
  CONCLUSIONS
  According to this whole population based study from Hungary, the incidence of lower limb major amputation is high with no change over the past 9 years. An explanation for this remains to be determined, as the traditional risk factors in Hungary do not account for it. The characteristics of major amputation (the rate of primary amputation, the ratio of below to above knee amputation and the age of the affected population) underline the importance of screening, early detection, improved vascular care and an optimal revascularization policy. Standardization and validation of amputation detection methods and reporting is essential.
authors.affiliation: Department of Angiology, St. Imre University Teaching Hospital, Budapest, Hungary. Electronic address: kolossendre@gmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Kolossváry
authors.affiliation: Obuda University, John von Neumann Faculty of Informatics, Applied Informatics Institute, Physiological Controls Group, Budapest, Hungary.
authors.forename: T
authors.initials: T
authors.lastname: Ferenci
authors.affiliation: National Institute for Quality- and Organizational Development in Healthcare and Medicines (Gyemszi), Budapest, Hungary.
authors.forename: T
authors.initials: T
authors.lastname: Kováts
authors.affiliation: Obuda University, John von Neumann Faculty of Informatics, Applied Informatics Institute, Physiological Controls Group, Budapest, Hungary.
authors.forename: L
authors.initials: L
authors.lastname: Kovács
authors.affiliation: Department of Cardiology, St. Imre University Teaching Hospital, Budapest, Hungary.
authors.forename: Z
authors.initials: Z
authors.lastname: Járai
authors.affiliation: Department of Vascular Surgery, University Pécs Medical Centre, Pécs, Hungary.
authors.forename: G
authors.initials: G
authors.lastname: Menyhei
authors.affiliation: Department of Angiology, St. Imre University Teaching Hospital, Budapest, Hungary.
authors.forename: K
authors.initials: K
authors.lastname: Farkas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data* / Q000639:trends*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006814:Hungary; D007866:Leg / Q000098:blood supply* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000601:surgery*; D012189:Retrospective Studies
keywords: Critical limb ischemia; Lower limb amputation; Peripheral arterial disease