A shift from high to low: trends in amputation in Australia over the last decade

http://poi.sagepub.com/content/early/2013/06/10/0309364613490441.abstract
Incidence of lower limb amputation in Australian hospitals from 2000 to 2010
Michael P Dillon1
Friedbert Kohler2,3
Victoria Peeva2
1National Centre for Prosthetics and Orthotics, La Trobe University, Victoria, Australia
2Braeside Hospital, Rehabilitation Medicine, New South Wales, Australia
3School of Public Health and Community Medicine, University New South Wales, Australia
Michael P Dillon, National Centre for Prosthetics and Orthotics, La Trobe University, Melbourne, VIC 3086, Australia. Email: michael.dillon@latrobe.edu.au
Abstract
Background: Contemporary literature reports that the incidence of lower limb amputation has declined in many countries. This impression may be misleading given that many publications only describe the incidence of lower limb amputations above the ankle and fail to include lower limb amputations below the ankle.
Objectives: To describe trends in the incidence of different levels of lower limb amputation in Australian hospitals over a 10-year period.
Study design: Descriptive.
Method: Data describing the age-standardised incidence of lower limb amputation were calculated from the Australian National Hospital Morbidity database and analysed for trends over a 10-year period.
Results: The age-standardised incidence of lower limb amputation remained unchanged over time (p = 0.786). A significant increase in the incidence of partial foot amputations (p = 0.001) and a decline in the incidence of transfemoral (p = 0.00) and transtibial amputations (p = 0.00) were observed. There are now three lower limb amputations below the ankle for every lower limb amputation above the ankle.
Conclusion: While the age-standardised incidence of all lower limb amputation has not changed, a shift in the proportion of lower limb amputations above the ankle and lower limb amputations below the ankle may be the result of improved management of precursor disease that makes partial foot amputation a more commonly utilised alternative to lower limb amputations above the ankle.
Clinical relevance This article highlights that although the incidence of lower limb amputation has remained steady, the proportion of amputations above the ankle and below the ankle has changed dramatically over the last decade. This has implications for how we judge the success of efforts to reduce the incidence of lower limb amputation and the services required to meet the increasing proportion of persons with amputation below the ankle

David G. Armstrong

Dedicated to amputation prevention, wound healing, diabetic foot, biotechnology and the intersection between medical devices and consumer electronics.

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