Abstract 15232: Lifetime Risk of Nontraumatic Lower-extremity Amputation: The Atherosclerosis Risk in Communities Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ning Ding ◽  
Yejin Mok ◽  
Yingying Sang ◽  
Maya Salameh ◽  
Weihong Tang ◽  
...  
Keyword(s):  
Black Women ◽  
Lower Extremity ◽  
Black Men ◽  
White Men ◽  
Lower Extremity Amputation ◽  
Lifetime Risk ◽  
Area Deprivation ◽  
Low Ses ◽  
Traumatic Amputation ◽  
Extremity Amputation

Introduction: Nontraumatic lower-extremity amputation is a serious clinical outcome. Major risk factors include peripheral artery disease and diabetic neuropathy. Although incidence rates of amputation have been reported, no lifetime risk estimates are available. Hypothesis: The lifetime risk of amputation is higher in men, blacks, and those of low socioeconomic status (SES). Methods: In 15,744 ARIC participants aged 45-64 at baseline (1987-89), we estimated the lifetime risk of amputation through age 80 by race-sex and race-SES using Fine and Gray’s proportional subhazards model accounting for the competing risk of death. This method is optimal for time-fixed exposures and thus our primary exposures are sex and race. SES included education, annual family income, and the Area Deprivation Index linked to census tract geocoding. Non-traumatic amputation was identified from hospitalization ICD codes (e.g., 84.1, Z89.4) and related operation codes. Results: There were 253 non-traumatic amputations during a median follow up of 29 years. Lifetime risk of amputation at age 80 was highest in black men (4.6%), followed by black women (2.8%), white men (1.1%) and white women (0.7%) ( Figure ). Blacks of low SES showed the highest lifetime risk (4.5%). Blacks with high SES had a higher lifetime risk of amputation than whites with low SES. The pattern was consistent when we investigated each of education (≤ vs. > high school), income (< vs. ≥$25,000) and Area Deprivation Index (< vs. ≥ race-specific median), separately. Conclusions: In this population-based cohort 5% of black men and 3% of black women experienced a non-traumatic amputation during their lifetime, while only 1% of white men and women had a hospitalization for amputation. The lifetime risk was higher among those with lower SES in both race groups. Future public health and primary care efforts should emphasize risk factor management (e.g., diabetes and smoking) among racial minority groups and those with low SES.

scholarly journals Dismounted complex blast injuries

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Paul Ryan ◽  
Claude Anderson ◽  
Steven Wilding
Keyword(s):  
Lower Extremity ◽  
Upper Extremity ◽  
The United States ◽  
Lower Extremity Amputation ◽  
Traumatic Amputation ◽  
Amputation Level ◽  
Skeletal Injury ◽  
Knee Amputation ◽  
The Us ◽  
Extremity Amputation

Category: Trauma Introduction/Purpose: The United States Medical Corps has continued to evaluate and define the injury patterns of our service members in an effort to prevent injury and improve combat casualty care. The pattern of injury can be predicted by the mechanism of injury. One of the more recently described and studied mechanisms has been coined the ‘dismounted complex blast injury. This injury pattern involves traumatic amputation of at least one leg with a second injury involving another extremity in addition to an injury to either the pelvis, the abdomen, or the urogenital region. The purpose of this study was to better define and describe the injuries occurring to the non amputated extremity. Methods: This is a retrospectively review of data from the US and UK Joint Theater Trauma Registries (JTTR) of consecutive patients admitted to the UK Role 3 hospital at Camp Bastion, Afghanistan, from January 1, 2009, to February 29, 2012. Data was obtained from the US JTTR (Joint Theatre Trauma Registry). Each patient was assigned an Injury Severity Score (ISS) and an Abbreviated Injury Scale (AIS) score. Only those patients with an AIS of 3 or greater (a serious injury) were included. All xrays and CT scans were evaluated by two board certified orthopaedic surgeons and one board certified musculoskeletal radiologist. Fisher’s exact test was used to compare categorical data and binomial logistic regression was be used to compare proportions of types of injuries by traumatic amputation level observed. Results: There were 295 patients with lower extremity injuries identified. 201 had traumatic lower extremity amputations, 140 with bilateral lower extremity amputations, 61 with single leg amputations. The mean age was 23.38 +/-3.77 years. All were male. Below the knee amputation was the most frequent amputation type observed, representing 55.7% of the amputations (29/52), the next most frequent was the through knee amputation representing 25%. The least frequent was the through ankle amputation. The presence of a symes level amputation was associated with an 8.1% increase in the odds of the presence of a skeletal foot injury in the rear lower extremity. There was also an association found between AKA level amputation and skeletal injury in the contralateral upper extremity . Conclusion: This is among the first studies to correlate level of injury and associated musculoskeletal injury for the Afghanistan theater of operations. The results of this data set demonstrate that proximal lower extremity amputation levels are significantly associated with distal upper extremity skeletal injury. In addition, the Symes level of amputation is significantly associated with contralateral foot fractures. Amputation levels proximal to the ankle often present with associated Genitourinary injuries. Unique to this study is the demonstration of a significant association of upper extremity injury with a more proximal lower extremity amputation level .

Review of Research on Prosthetic Devices for Lower Extremity Amputation

2006 ◽  
Vol 34 (5) ◽  
pp. 379-438 ◽  
Author(s):  
Diane M. Collins ◽  
Amol Karmarkar ◽  
Rick Relich ◽  
Paul F. Pasquina ◽  
Rory A. Cooper
Keyword(s):  
Lower Extremity ◽  
Lower Extremity Amputation ◽  
Prosthetic Devices ◽  
Extremity Amputation

1497-P: Secular Trends in Incidence and One-Year Mortality Rates of Lower Extremity Amputation in People with Diabetes in Hong Kong between 2001 and 2016

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1497-P
Author(s):  
HONGJIANG WU ◽  
AIMIN YANG ◽  
ERIC S. LAU ◽  
RONALD C. MA ◽  
ALICE P. KONG ◽  
...  
Keyword(s):  
Hong Kong ◽  
Lower Extremity ◽  
Mortality Rates ◽  
Secular Trends ◽  
Lower Extremity Amputation ◽  
One Year ◽  
Extremity Amputation

Lower-extremity amputation. Incidence, risk factors, and mortality in the Oklahoma Indian Diabetes Study

Diabetes ◽  
1993 ◽  
Vol 42 (6) ◽  
pp. 876-882 ◽  
Author(s):  
J. S. Lee ◽  
M. Lu ◽  
V. S. Lee ◽  
D. Russell ◽  
C. Bahr ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lower Extremity ◽  
Lower Extremity Amputation ◽  
Incidence Risk ◽  
Extremity Amputation

Does Perioperative Hemoglobin A1c Level Affect the Incidence, Pattern and Mortality of Lower Extremity Amputation?

2019 ◽  
Vol 17 (4) ◽  
pp. 354-364
Author(s):  
Hassan Al-Thani ◽  
Moamena El-Matbouly ◽  
Maryam Al-Sulaiti ◽  
Noora Al-Thani ◽  
Mohammad Asim ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Lower Extremity ◽  
Hazard Ratio ◽  
Lower Extremity Amputation ◽  
Group 4 ◽  
Group 3 ◽  
Group 5 ◽  
Group 2 ◽  
Extremity Amputation ◽  
Group 1

Background: We hypothesized that perioperative HbA1c influenced the pattern and outcomes of Lower Extremity Amputation (LEA). Methods: A retrospective analysis was conducted for all patients who underwent LEA between 2000 and 2013. Patients were categorized into 5 groups according to their perioperative HbA1c values [Group 1 (<6.5%), Group 2 (6.5-7.4%), Group 3 (7.5-8.4%), Group 4 (8.5-9.4%) and Group 5 (≥9.5%)]. We identified 848 patients with LEA; perioperative HbA1c levels were available in 547 cases (Group 1: 18.8%, Group 2: 17.7%, Group 3: 15.0%, Group 4: 13.5% and Group 5: 34.9%). Major amputation was performed in 35%, 32%, 22%, 10.8% and 13.6%, respectively. Results: The overall mortality was 36.5%; of that one quarter occurred during the index hospitalization. Mortality was higher in Group 1 (57.4%) compared with Groups 2-5 (46.9%, 38.3%, 36.1% and 31.2%, respectively, p=0.001). Cox regression analysis showed that poor glycemic control (Group 4 and 5) had lower risk of mortality post-LEA [hazard ratio 0.57 (95% CI 0.35-0.93) and hazard ratio 0.46 (95% CI 0.31-0.69)]; this mortality risk persisted even after adjustment for age and sex but was statistically insignificant. The rate of LEA was greater among poor glycemic control patients; however, the mortality was higher among patients with tight control. Conclusion: The effects of HbA1c on the immediate and long-term LEA outcomes and its therapeutic implications need further investigation.

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