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Differences in minor amputation rate in diabetic foot disease throughout Europe are in part explained by differences in disease severity at presentation

van Battum, P.; Schaper, N.; Prompers, L.; Apelqvist, Jan LU ; Jude, E.; Piaggesi, A.; Bakker, K.; Edmonds, M.; Holstein, P. and Jirkovska, A., et al. (2011) In Diabetic Medicine 28(2). p.199-205
Abstract
P>Objectives The incidence of minor amputation may vary significantly, and determinants of minor amputation have not been studied systematically. We evaluated minor amputation rate, the determinants of minor amputation and differences in amputation rate between European centres. Methods In the Eurodiale study, a prospective cohort study of 1232 patients (1088 followed until end-point) with a new diabetic foot ulcer were followed on a monthly basis until healing, death, major amputation or up to a maximum of 1 year. Ulcers were treated according to international guidelines. Baseline characteristics independently associated with minor amputation were examined using multiple logistic regression modelling. Based on the results of the... (More)
P>Objectives The incidence of minor amputation may vary significantly, and determinants of minor amputation have not been studied systematically. We evaluated minor amputation rate, the determinants of minor amputation and differences in amputation rate between European centres. Methods In the Eurodiale study, a prospective cohort study of 1232 patients (1088 followed until end-point) with a new diabetic foot ulcer were followed on a monthly basis until healing, death, major amputation or up to a maximum of 1 year. Ulcers were treated according to international guidelines. Baseline characteristics independently associated with minor amputation were examined using multiple logistic regression modelling. Based on the results of the multivariable analysis, a disease severity score was calculated for each patient. Results One hundred and ninety-four (18%) patients underwent a minor amputation. Predictors of minor amputation were depth of the ulcer (odds ratio 6.08, confidence interval 4.10-9.03), peripheral arterial disease (odds ratio 1.84, confidence interval 1.30-2.60), infection (odds ratio 1.56, confidence interval 1.05-2.30) and male sex (odds ratio 1.42, confidence interval 0.99-2.04). Minor amputation rate varied between 2.4 and 34% in the centres. Minor amputation rate in centres correlated strongly with disease severity score at the moment of presentation to the foot clinic (r = 0.75). Conclusions Minor amputation is performed frequently in diabetic foot centres throughout Europe and is determined by depth of the ulcer, peripheral arterial disease, infection and male sex. There are important differences in amputation rate between the European centres, which can be explained in part by severity of disease at presentation. This may suggest that early referral to foot clinics can prevent minor amputations. (Less)
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Contribution to journal
publication status
published
subject
keywords
diabetes, foot ulcer, infection, minor amputation, peripheral arterial, disease
in
Diabetic Medicine
volume
28
issue
2
pages
199 - 205
publisher
Wiley-Blackwell
external identifiers
  • wos:000286107000013
  • scopus:78651091303
ISSN
1464-5491
DOI
10.1111/j.1464-5491.2010.03192.x
language
English
LU publication?
yes
id
cf1a5ef8-52b1-4b86-8132-5da93c84ab11 (old id 1790932)
date added to LUP
2011-03-02 14:35:31
date last changed
2017-11-12 03:46:23
@article{cf1a5ef8-52b1-4b86-8132-5da93c84ab11,
  abstract     = {P>Objectives The incidence of minor amputation may vary significantly, and determinants of minor amputation have not been studied systematically. We evaluated minor amputation rate, the determinants of minor amputation and differences in amputation rate between European centres. Methods In the Eurodiale study, a prospective cohort study of 1232 patients (1088 followed until end-point) with a new diabetic foot ulcer were followed on a monthly basis until healing, death, major amputation or up to a maximum of 1 year. Ulcers were treated according to international guidelines. Baseline characteristics independently associated with minor amputation were examined using multiple logistic regression modelling. Based on the results of the multivariable analysis, a disease severity score was calculated for each patient. Results One hundred and ninety-four (18%) patients underwent a minor amputation. Predictors of minor amputation were depth of the ulcer (odds ratio 6.08, confidence interval 4.10-9.03), peripheral arterial disease (odds ratio 1.84, confidence interval 1.30-2.60), infection (odds ratio 1.56, confidence interval 1.05-2.30) and male sex (odds ratio 1.42, confidence interval 0.99-2.04). Minor amputation rate varied between 2.4 and 34% in the centres. Minor amputation rate in centres correlated strongly with disease severity score at the moment of presentation to the foot clinic (r = 0.75). Conclusions Minor amputation is performed frequently in diabetic foot centres throughout Europe and is determined by depth of the ulcer, peripheral arterial disease, infection and male sex. There are important differences in amputation rate between the European centres, which can be explained in part by severity of disease at presentation. This may suggest that early referral to foot clinics can prevent minor amputations.},
  author       = {van Battum, P. and Schaper, N. and Prompers, L. and Apelqvist, Jan and Jude, E. and Piaggesi, A. and Bakker, K. and Edmonds, M. and Holstein, P. and Jirkovska, A. and Mauricio, D. and Tennvall, G. Ragnarson and Reike, H. and Spraul, M. and Uccioli, L. and Urbancic, V. and van Acker, K. and van Baal, J. and Ferreira, I. and Huijberts, M.},
  issn         = {1464-5491},
  keyword      = {diabetes,foot ulcer,infection,minor amputation,peripheral arterial,disease},
  language     = {eng},
  number       = {2},
  pages        = {199--205},
  publisher    = {Wiley-Blackwell},
  series       = {Diabetic Medicine},
  title        = {Differences in minor amputation rate in diabetic foot disease throughout Europe are in part explained by differences in disease severity at presentation},
  url          = {http://dx.doi.org/10.1111/j.1464-5491.2010.03192.x},
  volume       = {28},
  year         = {2011},
}