Lower limb amputation in England: prevalence, regional variation and relationship with revascularisation, deprivation and risk factors. A retrospective review of hospital data

Naseer Ahmad; G Neil Thomas; Paramjit Gill; Colin Chan; Francesco Torella

doi:10.1177/0141076814557301

Lower limb amputation in England: prevalence, regional variation and relationship with revascularisation, deprivation and risk factors. A retrospective review of hospital data

J R Soc Med. 2014 Dec;107(12):483-9. doi: 10.1177/0141076814557301. Epub 2014 Nov 11.

Authors

Naseer Ahmad¹, G Neil Thomas², Paramjit Gill³, Colin Chan⁴, Francesco Torella⁵

Affiliations

¹ Liverpool Vascular and Endovascular Service (LiVES), Royal Liverpool University Hospital, Liverpool L7 8XP, UK naseer.ahmad@liv.ac.uk.
² Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham B15 2TT, UK.
³ Department of Primary Care Research, University of Birmingham, Birmingham B15 2TT, UK.
⁴ Department of Vascular Surgery, Wirral University Hospital NHS Foundation Trust, Wirral CH49, UK.
⁵ Liverpool Vascular and Endovascular Service (LiVES), Royal Liverpool University Hospital, Liverpool L7 8XP, UK.

Abstract

Objective: We describe the prevalence of major lower limb amputation across England and its relationship with revascularisation, patient demography and disease risk factors.

Design: Retrospective cohort study.

Setting: England 1 April 2003 to 31 March 2009.

Participants: Patients aged 50-84 years.

Main outcome measures: Age standardised prevalence rates were calculated using Hospital Episode Statistics as the numerator with census data as the denominator. The outcome measure 'amputation with revascularisation' was created if an amputation could be linked with a revascularisation. Logistic regression determined the odds of having an amputation with a revascularisation across England. Regression was performed unadjusted and repeated after controlling for demographic (age, sex, social deprivation) and disease risk factors (diabetes, hypertension, coronary heart disease, cerebrovascular disease, smoking).

Results: There were 25,312 amputations and 136,215 revascularisations, and 7543 cases were linked. The prevalence rate per 100,000 (95% confidence intervals) for amputation was 26.3 (26.0-26.6) with rates significantly higher in Northern England (North: 31.7; 31.0-32.3, Midlands: 26.0; 25.3-26.7, South: 23.1; 22.6-23.5). The revascularisation rate was 141.6 (140.8-142.3) with significantly higher rates again in Northern England (North: 182.1; 180.5-183.7, Midlands: 121.3; 119.8-122.9, South 124.9; 123.9-125.8). The odds of having an amputation with a revascularisation remained significantly higher in the North (OR 1.22; 1.13-1.33) even after controlling demographic and disease risk factors.

Conclusions: There is a North-South divide in England for both major lower limb amputation and revascularisation. The higher odds of having an amputation with a revascularisation in the North were not fully explained by greater levels of deprivation or disease risk factors.

Keywords: amputation; peripheral vascular disease; prevalence; revascularisation.

MeSH terms

Aged
Aged, 80 and over
Amputation, Surgical / statistics & numerical data*
Amputees / statistics & numerical data*
Cohort Studies
Diabetic Foot / epidemiology
Diabetic Foot / surgery
England / epidemiology
Female
Humans
Leg / blood supply*
Leg / surgery
Logistic Models
Male
Middle Aged
Peripheral Arterial Disease / epidemiology*
Peripheral Arterial Disease / surgery*
Prevalence
Residence Characteristics / statistics & numerical data
Retrospective Studies
Risk Assessment
Risk Factors