title: A Canadian population-based description of the indications for lower-extremity amputations and outcomes.
abstract: BACKGROUND
  To our knowledge, there have been no previously published reports characterizing lower-extremity amputations in Canada. The objective of this study was to describe the indications and outcomes of lower-extremity amputations in the Canadian population.
  
  
  METHODS
  We performed a retrospective cohort study of all adult patients who underwent lower-extremity amputation in Canada between 2006 and 2009. Patients were identified from the Canadian Institute for Health Information's Discharge Abstract Database, which includes all hospital admissions across Canada with the exception of the province of Quebec. Pediatric, trauma, and outpatients were excluded.
  
  
  RESULTS
  During the study period, 5342 patients underwent lower-extremity amputations in 207 Canadian hospitals. The mean age was 67 ± 13 years, and 68% were men. Amputations were most frequently indicated after admission for diabetic complications (81%), cardiovascular disease (6%), or cancer (3%). In total, 65% of patients were discharged to another inpatient or long-term care facility, and 26% were discharged home with or without extra support. Most patients were diabetic (96%) and most (65%) required a below-knee amputation. Predictors of prolonged (> 7 d) hospital stay included amputation performed by a general surgeon; cardiovascular risk factors, such as diabetes, hypertension, ischemic heart disease, congestive heart failure, or hyperlipidemia; and undergoing the amputation in the provinces of Newfoundland and Labrador, New Brunswick, or British Columbia.
  
  
  CONCLUSIONS
  There is variability in the delivery of lower-extremity amputations and postoperative hospital discharges among surgical specialists and regions across Canada. Future work is needed to investigate the reasons for this variability and to develop initiatives to shorten postoperative hospital stays.
authors.affiliation: All authors are from the Division of Vascular Surgery, University Health Network, University of Toronto, Toronto, Ont.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Kayssi
authors.affiliation: All authors are from the Division of Vascular Surgery, University Health Network, University of Toronto, Toronto, Ont.
authors.forename: Charles
authors.initials: C
authors.lastname: de Mestral
authors.affiliation: All authors are from the Division of Vascular Surgery, University Health Network, University of Toronto, Toronto, Ont.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Forbes
authors.affiliation: All authors are from the Division of Vascular Surgery, University Health Network, University of Toronto, Toronto, Ont.
authors.forename: Graham
authors.initials: G
authors.lastname: Roche-Nagle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D002170:Canada / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000601:surgery; D048909:Diabetes Complications / Q000453:epidemiology / Q000601:surgery; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000601:surgery; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome