Declining Incidence of Major Lower-Extremity Amputations in the Northern Danish Region Between 2016 and 2021: The Impact of Diabetes and Preventive Vascular Procedures

Abstract

Background

Preventing lower-extremity amputations (LEAs) is pivotal. In the present study, we aimed to examine the recent trends in nontraumatic LEAs seen in the Northern Danish Region.

Methods

Using data from the regional Business Intelligence unit, we identified all nontraumatic LEAs (n = 689) performed in people above 50 years of age in the Northern Danish Region between January 2016 and December 2021 (approximately 600,000 inhabitants). Persons with diabetes (n = 26,025) were identified based on International Classification of Diseases-10 codes and data from the National Health Insurance Service Registry, while preventive vascular procedures (n = 1,097) were identified using surgical codes. Major LEA was defined as any amputation above the ankle. Incidence rates were expressed as events per 1,000 person-years. Trends were described as differences between the periods 2016–2018 and 2019–2021.

Results

A total of 249 (36%) major LEAs were performed in people with diabetes. People with diabetes were younger (71 vs 77 years, P < 0.001) and more frequently male (70% versus 54%, P < 0.001). Between 2016–2018 and 2019–2021, the incidence of major LEA declined from 1.76 (95% CI: 1.75–1.76) to 1.39 (1.39–1.39) in people with diabetes and from 0.47 (0.47–0.47) to 0.20 (0.20–0.20) in people without diabetes (all P < 0.001). Simultaneously, the incidence of preventive vascular surgery increased from 2.26 (2.26–2.26) to 3.48 (3.48–3.48) in people with diabetes and declined slightly in people without 0.49 (0.49–0.49) to 0.47 (0.47–0.47) (all P < 0.001).

Conclusions

Despite significant declines in major LEA in both people with and without diabetes, most of the decline was driven by a large reduction in major LEAs in people without diabetes.