title: National trends in incidence and outcomes in lower extremity amputations in people with and without diabetes in Spain, 2001-2012.
abstract: OBJECTIVE
  To describe trends in the incidence and outcomes of lower-extremity amputations (LEAs) in patients with T1DM and T2DM in Spain, 2001-2012.
  
  
  METHODS
  We used national hospital discharge data. Incidence of discharges attributed to LEA procedures were calculated stratified by diabetes status and type of LEA. Joinpoint log-linear regression for incidence trends and logistic regression for factors associated with in-hospital mortality were used.
  
  
  RESULTS
  From 2001 to 2012, 73,302 minor LEAs and 64,710 major LEAs were performed. We found that incidence of minor LEA procedures in T1DM patients decreased by 9.84% per year from 2001 to 2008 and then remained stable through 2012. In T2DM patients, LEA increased by 1.89% per year over the entire study period. Among patients with T1DM, major LEA incidence rate decreased by 10.5% from 2001 to 2012. In patients with T2DM, it increased by 4.29% from 2001 to 2004, and then decreased by 1.85% through 2012. In-hospital mortality after major or minor LEAs was associated with older age in all groups and with being female in T2DM and in people without diabetes.
  
  
  CONCLUSIONS
  Our national data show a decrease in the incidence of minor LEAs in patients with diabetes and in major LEAS in patients with T1DM over the period of study. In patients with T2DM, we found a decrease between 2004 and 2012. An additional improvement in preventive care, such as the introduction of diabetes foot units in hospitals, is necessary.
authors: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain. Electronic address: ana.lopez@urjc.es.
authors: Ana
authors: A
authors: Lopez-de-Andres
authors: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain.
authors: Rodrigo
authors: R
authors: Jiménez-García
authors: La Paloma Hospital, Las Palmas de Gran Canaria, Las Palmas, Spain.
authors: Javier
authors: J
authors: Aragón-Sánchez
authors: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain.
authors: Isabel
authors: I
authors: Jiménez-Trujillo
authors: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain.
authors: Valentin
authors: V
authors: Hernández-Barrera
authors: Medicine Department, Hospital Clínico San Carlos, Madrid, Spain.
authors: Manuel
authors: M
authors: Méndez-Bailón
authors: Medicine Department, Hospital Universitario del Sureste, Madrid, Spain.
authors: Jose Ma
authors: JM
authors: de Miguel-Yanes
authors: Health Security Agency, Ministry of Health, Madrid, Spain.
authors: Napoleon
authors: N
authors: Perez-Farinos
authors: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain.
authors: Pilar
authors: P
authors: Carrasco-Garrido
mesh_terms: D000671:Amputation, Surgical / Q000639:trends*; D048909:Diabetes Complications / Q000453:epidemiology* / Q000601:surgery; D017719:Diabetic Foot / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013030:Spain / Q000453:epidemiology
keywords: Diabetes; Hospitalization; In-hospital mortality; Incidence; Length of stay; Lower-extremity amputations