Department of Vascular Medicine, HELIOS Hospital Krefeld; Department of Internal Medicine, Angiology, Endocrinology and Diabetology, Protestant Hospital Mettmann; Angiology Section, Department of Cardiology and Angiology, University of Münster.
Dtsch Arztebl Int. 2017 Feb 24;114(7):130-136. doi: 10.3238/arztebl.2017.0130.
Declining amputation rates have been reported in multiple countries in recent years. It is not yet known whether amputation rates have declined in Germany as well.
On the basis of DRG (diagnosis-related group) data, we received a list from the German Federal Statistical Office of all major and minor amputations documented in German hospitals from 2005 to 2014. Changes over this period were studied with linear regression.
The absolute number of amputations per year in Germany rose slightly from 55 689 in 2005 to 57 637 (+3.5%) in 2014. After the exclusion of cases in which the main diagnosis was trauma, intoxication, musculoskeletal disease, diseases of the skin and subcutaneous tissue, or neoplasia, the corresponding numbers were 48 043 in 2005 and 48 561 in 2014 (+1.1%). The age-adjusted rate of major amputations per 100 000 persons per year fell from 23.3 to 16.1 (-30.9%), while the rate of minor amputations rose from 35.0 to 43.9 (+25.4%). The percentage of major amputations that took place in patients with diabetes mellitus as the main diagnosis or a side diagnosis declined from 70.2% to 63.7%. For all of these changes, p <0.0001.
From 2005 to 2014, the major amputation rate fell by 30.9% while the minor amputation rate rose by 25.4%. The goal of lowering amputation rates still further will be best served not only by applying the recognized preventive measures in patients with foot lesions, but also by further research into the causes of the recent changes in amputation numbers. Prospective registries will be needed.
近年来，多个国家的截肢率呈下降趋势。德国的截肢率是否也有所下降尚不清楚。
基于诊断相关分组（DRG）数据，我们从德国联邦统计局收到了一份清单，其中列出了 2005 年至 2014 年德国医院记录的所有主要和次要截肢病例。在此期间的变化通过线性回归进行了研究。
德国每年的截肢绝对数量从 2005 年的 55689 例略有上升至 2014 年的 57637 例（增长 3.5%）。排除主要诊断为创伤、中毒、肌肉骨骼疾病、皮肤和皮下组织疾病或肿瘤的病例后，相应的数字为 2005 年的 48043 例和 2014 年的 48561 例（增长 1.1%）。每 10 万人中年龄调整后的主要截肢率从 23.3 例下降至 16.1 例（下降 30.9%），而次要截肢率从 35.0 例上升至 43.9 例（上升 25.4%）。以糖尿病为主要诊断或次要诊断的患者进行主要截肢的比例从 70.2%下降至 63.7%。所有这些变化均具有统计学意义（p<0.0001）。
2005 年至 2014 年，主要截肢率下降了 30.9%，而次要截肢率上升了 25.4%。要进一步降低截肢率，不仅要在有足部病变的患者中应用公认的预防措施，还需要进一步研究导致近期截肢数量变化的原因。需要前瞻性登记。
