National trends in incidence and outcomes in lower extremity amputations in people with and without diabetes in Spain, 2001-2012.
AIMS
To describe trends in the incidence and outcomes of lower-extremity amputations (LEAs) in patients with T1DM and T2DM in Spain, 2001-2012.


METHODS
We used national hospital discharge data. Incidence of discharges attributed to LEA procedures were calculated stratified by diabetes status and type of LEA. Joinpoint log-linear regression for incidence trends and logistic regression for factors associated with in-hospital mortality were used.


RESULTS
From 2001 to 2012, 73,302 minor LEAs and 64,710 major LEAs were performed. We found that incidence of minor LEA procedures in T1DM patients decreased by 9.84% per year from 2001 to 2008 and then remained stable through 2012. In T2DM patients, LEA increased by 1.89% per year over the entire study period. Among patients with T1DM, major LEA incidence rate decreased by 10.5% from 2001 to 2012. In patients with T2DM, it increased by 4.29% from 2001 to 2004, and then decreased by 1.85% through 2012. In-hospital mortality after major or minor LEAs was associated with older age in all groups and with being female in T2DM and in people without diabetes.


CONCLUSIONS
Our national data show a decrease in the incidence of minor LEAs in patients with diabetes and in major LEAS in patients with T1DM over the period of study. In patients with T2DM, we found a decrease between 2004 and 2012. An additional improvement in preventive care, such as the introduction of diabetes foot units in hospitals, is necessary.
['Lopez-de-Andres|Ana|A|', 'Jiménez-García|Rodrigo|R|', 'Aragón-Sánchez|Javier|J|', 'Jiménez-Trujillo|Isabel|I|', 'Hernández-Barrera|Valentin|V|', 'Méndez-Bailón|Manuel|M|', 'de Miguel-Yanes|Jose Ma|JM|', 'Perez-Farinos|Napoleon|N|', 'Carrasco-Garrido|Pilar|P|']
D000671:Amputation D048909:Diabetes Complications D017719:Diabetic Foot D005260:Female D006801:Humans D015994:Incidence D035002:Lower Extremity D008297:Male D008875:Middle Aged D013030:Spain
Incidence Diabetes Lower-extremity amputations Hospitalization In-hospital mortality Length of stay