Temporal trends in major, minor and recurrent lower extremity amputations in people with and without diabetes in Belgium from 2009 to 2018 #ActAgainstAmputation @alpslimb

Important work from Lauwers and coworkers and the Belgian Amputation Group.

Key points:

  • Diabetic foot disease is the main reason for lower extremity amputation (LEA).
  • The incidence of major amputations reduced by 45% in diabetics in Belgium.
  • The incidence of minor LEAs in people with diabetes remained stable.
  • The incidence of secondary amputations in people with diabetes remained stable.
  • Have a look at the gender differences in people with and without diabetes. Bottom line: insignificant in people without, but massive difference in people with diabetes


This study assessed temporal trends in the incidence of lower extremity amputations (LEA) in Belgium from 2009 to 2018, and subsequent secondary amputation rates.


Nationwide data on LEA were collected. Sex- and age-adjusted annual incidence rates were calculated. Time trends were analysed in negative binomial models. The incidence of secondary interventions, defined as either any ipsilateral reamputation or any contralateral amputation, was studied with death as competing risk.


41 304 amputations were performed (13 247 major, 28 057 minor). In individuals with diabetes, the amputation rate (first amputation per patient per year) decreased from 143.6/100.000 person-years to 109.7 (IRR 0.97 per year, 95%CI 0.96–0.98, p<0.001). The incidence of major LEAs decreased from 56.2 to 30.7 (IRR 0.93, 95%CI 0.91–0.94, p<0.001); the incidence of minor amputations showed a non-significant declining trend in women (54.3 to 45.0/100 000 person years, IRR 0.97 per year, 95%CI 0.96-0.99), while this remained stable in men with diabetes (149.2 to 135.3/100 000 person years, IRR 1.00 per year, 95%CI 0.98-1.01). In individuals without diabetes, the incidence of major amputation didn’t change significantly, whereas minor amputation incidence increased (8.0 to 10.6, IRR 1.04, 95%CI 1.03–1.05, p<0.001). In individuals with diabetes, one-year secondary intervention rates were high (31.3% after minor, 18.4% after major LEA); the incidence of secondary amputations didn’t change.


A significant decline in the incidence rate of major LEA was observed in people with diabetes. This decline was not accompanied by a significant rise in minor LEA. The incidence of secondary interventions remained stable.

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