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Major Lower Limb Amputations and Amputees in an Aging Population in Southwest Finland 2007–2017
Clinical Interventions in Aging ( IF 3.6 ) Pub Date : 2022-06-08 , DOI: 10.2147/cia.s361547 Veerakaisa Koivunen 1 , Vaiva Dabravolskaite 1, 2 , Veikko Nikulainen 1, 2 , Markus Juonala 1, 3 , Päivi Helmiö 1, 2 , Harri Hakovirta 1, 2, 4
Clinical Interventions in Aging ( IF 3.6 ) Pub Date : 2022-06-08 , DOI: 10.2147/cia.s361547 Veerakaisa Koivunen 1 , Vaiva Dabravolskaite 1, 2 , Veikko Nikulainen 1, 2 , Markus Juonala 1, 3 , Päivi Helmiö 1, 2 , Harri Hakovirta 1, 2, 4
Affiliation
Purpose: The aim of the present study was to describe and analyze changes in the incidences of lower extremity amputations (LEAs), patient characteristics, vascular history of amputees and survival in Southwest Finland.
Patients and Methods: This is a retrospective patient study in the Hospital District of Southwest Finland. All consecutive patients with atherosclerosis and diabetes-caused LEA, between 1st January 2007 and 31st December 2017, were included. The annual incidences of major LEA patients were statistically standardized. Patients’ diagnoses, functional status, previous revascularizations and minor amputations were recorded, and survival was analyzed.
Results: During the 11-year-period major LEAs were performed on 891 patients, 118 (13.2%) were urgent operations. The overall incidence of major LEA was 17.2/100 000 and was age-dependent (3.1 for ≤ 64 years, 34.3 for 65– 74 years, 81.5 for 75– 84 years, 216 for ≥ 85 years). A decrease in incidence was detected in the < 65 year-age-group (incidence 4.98 in 2007 and 1.88 in 2017; p = 0.0018). Among older age groups, there was no significant change. Half (50.6%) of all amputees were diabetics. Altogether, 472 patients (53.0%) had a history of revascularization before LEA. 80.1% of index amputations were transfemoral and 19.9% transtibial. Re-surgery was performed on 94 (10.5%) patients. The 1-, 3- and 5-year overall survival were 56%, 30%, and 18%, respectively.
Conclusion: Our results suggest that in an aging population, despite good availability of vascular services, a significant number of patients are not fit for active revascularization, and LEA is the only feasible treatment for critical limb ischemia.
Keywords: aging, major amputation, diabetes, peripheral artery disease
中文翻译：
2007-2017 年芬兰西南部人口老龄化的主要下肢截肢和截肢者
目的：本研究的目的是描述和分析芬兰西南部下肢截肢 (LEA) 发生率、患者特征、截肢者的血管病史和生存率的变化。
患者和方法：这是一项在芬兰西南部医院区进行的回顾性患者研究。纳入了 2007 年 1 月 1 日至 2017 年 12 月 31 日期间所有连续患有动脉粥样硬化和糖尿病引起的 LEA 的患者。主要 LEA 患者的年发病率进行了统计标准化。记录患者的诊断、功能状态、先前的血运重建和小截肢，并分析生存情况。
结果：在 11 年期间，对 891 名患者进行了主要的 LEA，其中 118 名（13.2%）是紧急手术。主要 LEA 的总发病率为 17.2/100 000，并且与年龄有关（≤64 岁为 3.1，65-74 岁为 34.3，75-84 岁为 81.5，≥85 岁为 216）。< 65 岁年龄组的发病率有所下降（2007 年发病率为 4.98，2017 年发病率为 1.88；p = 0.0018）。在老年组中，没有显着变化。所有截肢者中有一半（50.6%）是糖尿病患者。总共有 472 名患者 (53.0%) 在 LEA 之前有血运重建史。80.1% 的指数截肢是经股骨截肢，19.9% 是胫骨截肢。对 94 名 (10.5%) 患者进行了再次手术。1 年、3 年和 5 年总生存率分别为 56%、30% 和 18%。
结论：我们的研究结果表明，在人口老龄化中，尽管血管服务的可用性很好，但仍有大量患者不适合主动血运重建，而 LEA 是治疗严重肢体缺血的唯一可行方法。
关键词：衰老，大截肢，糖尿病，外周动脉疾病
更新日期：2022-06-08
Patients and Methods: This is a retrospective patient study in the Hospital District of Southwest Finland. All consecutive patients with atherosclerosis and diabetes-caused LEA, between 1st January 2007 and 31st December 2017, were included. The annual incidences of major LEA patients were statistically standardized. Patients’ diagnoses, functional status, previous revascularizations and minor amputations were recorded, and survival was analyzed.
Results: During the 11-year-period major LEAs were performed on 891 patients, 118 (13.2%) were urgent operations. The overall incidence of major LEA was 17.2/100 000 and was age-dependent (3.1 for ≤ 64 years, 34.3 for 65– 74 years, 81.5 for 75– 84 years, 216 for ≥ 85 years). A decrease in incidence was detected in the < 65 year-age-group (incidence 4.98 in 2007 and 1.88 in 2017; p = 0.0018). Among older age groups, there was no significant change. Half (50.6%) of all amputees were diabetics. Altogether, 472 patients (53.0%) had a history of revascularization before LEA. 80.1% of index amputations were transfemoral and 19.9% transtibial. Re-surgery was performed on 94 (10.5%) patients. The 1-, 3- and 5-year overall survival were 56%, 30%, and 18%, respectively.
Conclusion: Our results suggest that in an aging population, despite good availability of vascular services, a significant number of patients are not fit for active revascularization, and LEA is the only feasible treatment for critical limb ischemia.
Keywords: aging, major amputation, diabetes, peripheral artery disease
中文翻译：
2007-2017 年芬兰西南部人口老龄化的主要下肢截肢和截肢者
目的：本研究的目的是描述和分析芬兰西南部下肢截肢 (LEA) 发生率、患者特征、截肢者的血管病史和生存率的变化。
患者和方法：这是一项在芬兰西南部医院区进行的回顾性患者研究。纳入了 2007 年 1 月 1 日至 2017 年 12 月 31 日期间所有连续患有动脉粥样硬化和糖尿病引起的 LEA 的患者。主要 LEA 患者的年发病率进行了统计标准化。记录患者的诊断、功能状态、先前的血运重建和小截肢，并分析生存情况。
结果：在 11 年期间，对 891 名患者进行了主要的 LEA，其中 118 名（13.2%）是紧急手术。主要 LEA 的总发病率为 17.2/100 000，并且与年龄有关（≤64 岁为 3.1，65-74 岁为 34.3，75-84 岁为 81.5，≥85 岁为 216）。< 65 岁年龄组的发病率有所下降（2007 年发病率为 4.98，2017 年发病率为 1.88；p = 0.0018）。在老年组中，没有显着变化。所有截肢者中有一半（50.6%）是糖尿病患者。总共有 472 名患者 (53.0%) 在 LEA 之前有血运重建史。80.1% 的指数截肢是经股骨截肢，19.9% 是胫骨截肢。对 94 名 (10.5%) 患者进行了再次手术。1 年、3 年和 5 年总生存率分别为 56%、30% 和 18%。
结论：我们的研究结果表明，在人口老龄化中，尽管血管服务的可用性很好，但仍有大量患者不适合主动血运重建，而 LEA 是治疗严重肢体缺血的唯一可行方法。
关键词：衰老，大截肢，糖尿病，外周动脉疾病
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