Sustained reduction in major amputations in diabetic patients: 628 amputations in 461 patients in a defined population over a 20-year period

Acta Orthop. 2008 Oct;79(5):665-73. doi: 10.1080/17453670810016696.


Background and purpose: With an ageing population and an increasing incidence of diabetes, reduction of the number of diabetes-related amputations becomes increasingly difficult to achieve and maintain. There is controversy in this respect regarding the degree of success. We started a multidisciplinary treatment program for diabetic foot ulcers in 1982, and have now assessed incidence rates of amputations from 1982 through 2001.

Methods: In a defined population, gradually increasing from 199,000 to 234,000, all diabetes-related amputations of the lower extremity from toe to hip were recorded from January 1, 1982 to December 31, 2001, using several sources of information.

Results: The incidence of major amputations decreased by 0.57 from 16 (11-22) to 6.8 (6.1-7.5) per 100,000 inhabitants between the first and last 4-year period. The most substantial decrease was seen in patients aged 80 years and older. The fraction of amputations with a final level at or below the ankle (n = 240) increased from 0.23 in the first 4-year period to 0.31, 0.49, 0.47, and 0.49 in the following 4-year periods. The overall fraction of re-amputation was 0.34 in the first 4- year period and 0.27, 0.21, 0.32, and 0.21 in the following 4-year periods. The fraction of amputations in diabetic patients that were channeled through the footcare team prior to amputation increased from 0.51 in the first 4- year period to 0.83, 0.86, 0.90, and 0.90 in the following 4-year periods.

Interpretation: Our findings indicate that a substantial decrease in the incidence of major lower extremity amputations in diabetic patients has been achieved and maintained.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Amputation* / statistics & numerical data
  • Diabetic Foot / epidemiology
  • Diabetic Foot / prevention & control
  • Diabetic Foot / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Leg / surgery
  • Male
  • Middle Aged
  • Prospective Studies
  • Sweden / epidemiology
  • Treatment Outcome