National trends in incidence and outcomes in lower extremity amputations in people with and without diabetes in Spain, 2001-2012

Diabetes Res Clin Pract. 2015 Jun;108(3):499-507. doi: 10.1016/j.diabres.2015.01.010. Epub 2015 Apr 2.


Aims: 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.

Keywords: Diabetes; Hospitalization; In-hospital mortality; Incidence; Length of stay; Lower-extremity amputations.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Amputation / trends*
  • Diabetes Complications / epidemiology*
  • Diabetes Complications / surgery
  • Diabetic Foot / epidemiology*
  • Diabetic Foot / surgery
  • Female
  • Humans
  • Incidence
  • Lower Extremity / surgery*
  • Male
  • Middle Aged
  • Spain / epidemiology