Amputation rates are rising in elderly despite advances in treatment

August 05, 1999

Elderly Americans are at increased risk for having a leg or foot amputated, according to a study by researchers at Northwestern University Medical School and the Institute for Health Services Research and Policy Studies at Northwestern University.

Results of their study linked the recently escalating amputation rate to the undiminished prevalence of diabetes, which heightens risk for advanced vascular disease and diabetes-related complications, such as leg ulcers.

The increased number of amputations also was related to limited growth in hospitals' capacity to perform lower-extremity bypass surgery and angioplasty.

The amputation study, which was funded by the U.S. Agency for Health Care Policy and Research, appears in the August issue of the American Journal of Public Health.

Joe Feinglass, research associate professor of medicine, and colleagues at Northwestern and at the University of Chicago examined population-based rates of above- and below-the-knee amputation procedure for Americans by age, sex and other factors between 1979 and 1996.

They found that amputation rates rose at the beginning of the study period but were initially reversed in the mid-1980s following the introduction of lower-extremity bypass surgery and the ongoing decline in the prevalence of hypertension, ischemic heart disease and smoking.

However, by the mid-1990s, even with the advent of endovascular stents, thrombolytic therapy, new imaging technology and improved antibiotics, the downward trend flattened out and amputation rates began rising again.

"In 1988 to 1989, large increases in lower-extremity angioplasty procedures were accompanied by a temporary spike in the rate of bypass procedures. After 1993 to 1994, major amputation rates increased significantly while lower-extremity bypass procedures increased more modestly, consistent with relatively fixed hospital vascular surgery capacity," Feinglass said.

The researchers found that by 1996, the frequency of above- and below-the-knee amputation had increased from a 17-year average of 54,000 to 76,000 -- an 11 percent increase in age-adjusted rates from 1979-80 to 1995-96. It is estimated that 40 to 60 percent of above- and below-the-knee amputations involved patients with diabetes mellitus.

Men had over 70 percent higher above-the-knee and 45 percent higher below-the-knee amputation rates than women.

"Resolving the paradox of increasing amputation rates in the face of improved medical and surgical care will require a closer examination of the frequency and circumstances of primary amputation rates in the United States," Feinglass said.

The most important predisposing risk factors for lower-extremity vascular disease are male gender, advanced age, smoking, coronary heart disease, diabetes, severe hypertension and high cholesterol levels. Feinglass's co-researchers on this study were Jacqueline L. Brown, M.D., clinical instructor and faculty development fellow in general internal medical; Anthony LoSasso, research professor; Larry M. Manheim, research scientist and professor; Sanjiv J. Shah; and William H. Pearce, M.D., professor of surgery, of Northwestern University Medical School. LoSasso and Manheim also are with the Institute for Health Services Research and Policy Studies at Northwestern University. Also collaborating was Min-Woon Sohn of the University of Chicago.

This study also was supported by a grant from the National Heart, Lung, and Blood Institute.
-end-


Northwestern University

Related Diabetes Articles from Brightsurf:

New diabetes medication reduced heart event risk in those with diabetes and kidney disease
Sotagliflozin - a type of medication known as an SGLT2 inhibitor primarily prescribed for Type 2 diabetes - reduces the risk of adverse cardiovascular events for patients with diabetes and kidney disease.

Diabetes drug boosts survival in patients with type 2 diabetes and COVID-19 pneumonia
Sitagliptin, a drug to lower blood sugar in type 2 diabetes, also improves survival in diabetic patients hospitalized with COVID-19, suggests a multicenter observational study in Italy.

Making sense of diabetes
Throughout her 38-year nursing career, Laurel Despins has progressed from a bedside nurse to a clinical nurse specialist and has worked in medical, surgical and cardiac intensive care units.

Helping teens with type 1 diabetes improve diabetes control with MyDiaText
Adolescence is a difficult period of development, made more complex for those with Type 1 diabetes mellitus (T1DM).

Diabetes-in-a-dish model uncovers new insights into the cause of type 2 diabetes
Researchers have developed a novel 'disease-in-a-dish' model to study the basic molecular factors that lead to the development of type 2 diabetes, uncovering the potential existence of major signaling defects both inside and outside of the classical insulin signaling cascade, and providing new perspectives on the mechanisms behind insulin resistance in type 2 diabetes and possibly opportunities for the development of novel therapeutics for the disease.

Tele-diabetes to manage new-onset diabetes during COVID-19 pandemic
Two new case studies highlight the use of tele-diabetes to manage new-onset type 1 diabetes in an adult and an infant during the COVID-19 pandemic.

Genetic profile may predict type 2 diabetes risk among women with gestational diabetes
Women who go on to develop type 2 diabetes after having gestational, or pregnancy-related, diabetes are more likely to have particular genetic profiles, suggests an analysis by researchers at the National Institutes of Health and other institutions.

Maternal gestational diabetes linked to diabetes in children
Children and youth of mothers who had gestational diabetes during pregnancy are at increased risk of diabetes themselves, according to new research published in CMAJ (Canadian Medical Association Journal).

Two diabetes medications don't slow progression of type 2 diabetes in youth
In youth with impaired glucose tolerance or recent-onset type 2 diabetes, neither initial treatment with long-acting insulin followed by the drug metformin, nor metformin alone preserved the body's ability to make insulin, according to results published online June 25 in Diabetes Care.

People with diabetes visit the dentist less frequently despite link between diabetes, oral health
Adults with diabetes are less likely to visit the dentist than people with prediabetes or without diabetes, finds a new study led by researchers at NYU Rory Meyers College of Nursing and East Carolina University's Brody School of Medicine.

Read More: Diabetes News and Diabetes Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.