Population-based secular trends in lower-extremity amputation for diabetes and peripheral artery disease

Background — The evolving clinical burden of limb loss secondary to diabetes and peripheral artery (PAD) disease remains poorly characterized. The aim of this study was to examine secular trends in the rate of lower extremity amputations related to diabetes and PAD, or both.

Methods — We included all individuals ≥40 years old that underwent diabetes and/or PAD-related lower extremity amputations in Ontario, Canada (2005-2016). We identified patients and amputations through deterministic linkage of administrative health databases. Quarterly rates (per 100,000 individuals ≥40 years old) of any (major or minor) amputation as well as of major amputation alone were calculated. We used time-series analyses using exponential smoothing models to characterize secular trends and forecast two years forward in time.

Results — A total of 20,062 patients underwent any lower extremity amputations, of which 12,786 (63.7%) underwent a major (above ankle) amputation. Diabetes was present in 81.8%; PAD in 93.8%; and both diabetes and PAD in 75.6%. The rate of any amputation initially declined from 9.88 to 8.62 per 100,000 between 2005Q2 and 2010Q4, but increased again by 2016Q1 to 10.0 per 100,000 (P=0.003). We observed a significant increase in the rate of any amputation among patients with diabetes, and with both diabetes and PAD. Major amputations did not significantly change among patients with diabetes and/or PAD.

Interpretation — Diabetes and/or PAD-related lower extremity amputations have increased over the last decade. These data support renewed efforts to prevent and decrease the burden of limb loss.