Endocrine Abstracts

Background and Aim: Recent international studies indicate a secular decrease in the proportion of patients with diabetes who undergo lower limb amputations (LLA), and the same trend is observed in the national quality indicator. The validity of electronic databases and quality indicators are limited by multiple discharges and precision of coding. Furthermore, amputation codes included in the quality indicator do not include all amputations. We therefore aim to investigate the recent incidence of LLA in the catchment area of a middle-sized Norwegian hospital, and to compare it with data collected during 1990–99.

Methodes: Medical records for all patients identified with LLA by the electronic discharge registers at Innlandet Hospital, Elverum, from 2013 through 2019 were retrieved. All codes for amputations and exarticulations were included, and amputations were verified by manual review by two of the authors. Traumatic and cancer-related amputations were excluded. Both minor and major amputations were included in further analyses. Diabetes was defined by the WHO criteria. The prevalence of diabetes was calculated using data from the Norwegian Prescription Database and Statistics Norway.

Results: We identified 169 non-traumatic, non-cancer related amputations in 127 patients, of which 77 had diabetes. The proportion of amputees with diabetes had increased from 44% in the previous period to 61% in the recent data. Ten percent had type 1 diabetes compared to 4% during 1990–99. We estimated that 0.23% of individuals on antidiabetic drugs in the catchment area, underwent an amputation per year in the period 2013–19, compared to 0.31 % in 1990–99. The average absolute number of diabetics undergoing an LLA per year was 11 in both periods. Multiple amputations were common both in persons with and without diabetes and was present in 26% of the amputees, even though a high proportion in both groups underwent vascular surgery before amputation. Detailed information and further results will be provided.

Conclusion: Our findings suggest that the proportion of diabetics among patients undergoing non-traumatic, non-cancer related lower limb amputations has increased over the past decades. Multiple amputations are still common, despite comprehensive preoperative investigations and other surgical interventions.