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Amputation rates of the lower limb by amputation level - observational study using German national hospital discharge data from 2005 to 2015.
Autor | Spoden M,
Nimptsch U, Mansky
T |
Journal | BMC
Health Serv Res 2019; 19(1):8 doi.org/ [1]10.1186/s12913-018-3759-5 [2] |
Abstract
Background In international
comparisons, rates of amputations of the lower limb are relatively
high in Germany. This study aims to analyze trends in lower limb
amputations over time, as well as outcomes of care concerning
in-hospital mortality and reamputation rates during the same hospital
stay which might indicate the quality of surgical and perioperative
health care processes.
Methods
This work is an observational population-based study using
complete national hospital discharge data (Diagnosis-Related Group
Statistics (DRG Statistics)) from 2005 to 2015. All inpatient cases
with lower limb amputation were identified and stratified by eight
amputation levels. Time trends of case numbers and in-hospital
mortality were studied age-sex standardized. For inpatient cases with
reamputation during the same hospital stay, first and last amputation
levels were cross tabulated.
Results
A total of 55,595 amputations of the lower limb in 2015
(52,096 in 2005) were identified. After age-sex standardization to the
demographic structure of 2005, a relative decrease of − 11.1% was
revealed (men − 2.6%, women − 25.0%). The stratified analysis
by amputation levels showed that the decreases were induced by higher
amputation levels, whereas the amputation levels of toe/foot ray after
standardization still showed a relative increase of + 12.8%.
In-hospital mortality of all cases with lower limb amputation fell
from 19.8% in 2005 to 17.4% in 2015 (SMR 0.89 [95% CI 0.86; 0.92]).
The percentage of reamputations during the same hospital stay declined
from 13.2 to 10.2%.
Conclusions The number of
lower limb amputations declined in Germany, however distinctly
stronger in women than in men. The observed decreases of in-hospital
mortality as well as of reamputation rates point to improvements in
perioperative health care. Despite these indications of improvements,
the distinct increase in case numbers at the level of toe/foot ray
calls for additional targeted prevention efforts, especially for
patients with diabetes.
/10.1186/s12913-018-3759-5
/10.1186/s12913-018-3759-5
/10.1186/s12913-018-3759-5
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