Declining incidence of major lower-extremity amputations in the Northern Danish Region between 2016 and 2021: The impact of diabetes and preventive vascular procedures

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

Methods:
Using surgical codes and data from the regional Business Intelligence unit we identified all non-traumatic 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 ICD-10 codes and general practitioner fees for treatment of chronic diseases, while preventive vascular procedures (n=1,512) were identified using surgical codes. Major LEA was defined as any amputation above the ankle. Incidence-rates were expressed as incidence 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 undergoing LEA were younger (73 vs 77 years, p<0.01) and more frequently male (70% versus 58%, p<0.01) compared to people without diabetes. 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<0.01). In the same periods, the incidence of preventive surgery increased from 3.14 (3.14-3.14) to 4.93 (4.93-4.94) in people with diabetes, and from 0.63 (0.63-0.63) to 0.67 (0.67-0.67) in people without diabetes (all p<0.01).

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