Department of Cardiovascular and Thoracic Surgery, Odense University Hospital, Odense, Denmark; Department of Vascular Surgery, Kolding Hospital, Kolding, Denmark.
Departments of Vascular Surgery and Vascular Research Unit, Viborg Hospital, Viborg, Denmark.
Eur J Vasc Endovasc Surg. 2019 Nov;58(5):729-737. doi: 10.1016/j.ejvs.2019.06.007. Epub 2019 Sep 21.
The aim of this nationwide study was to provide insight into the incidence and geographical distribution of vascular services and major amputations in patients with peripheral arterial disease (PAD) in Denmark.
The incidence of major amputation caused by PAD was investigated by linking data from population based healthcare and administrative databases. The study period was divided into three parts, i.e. 1997-2002, 2003-2008, and 2009-2014. Amputation rates and revascularisation rates per 100 000 inhabitants ≥ 50 years of age were calculated and the association was displayed using scatter plots. The association between amputation rates and revascularisation rates was explored using a mixed effect model. Multivariable logistic regression was used to identify risk factors for having amputation without prior revascularisation relative to having amputation with prior revascularisation.
During 1997-2014, 13 075 first time major amputations were performed. The proportions of patients with diabetes as well as atherosclerotic comorbidity increased through the decades. The incidence rate decreased from 41.67 per 100 000 citizens ≥ 50 years of age in 1997-2002, to 32.53 in 2009-2014 (r = -0.88, p < .001), but with municipal differences. In parallel, revascularisations increased from 166.63 per 100 000 citizens ≥ 50 years of age in 1997-2002, to 239.05 in 2009-2014 (r = 0.83, p < .001). The percentage of patients evaluated by a vascular surgeon within a year prior to amputation increased from 23.7% to 31.3% (p < .001), while no increase in the proportion having revascularisation within a year prior to amputation was seen. Multivariable logistic regression analysis showed that diabetes mellitus (OR 1.28; CI 1.17-1.40), stroke (OR 1.66; CI 1.52-1.81), coronary heart disease (OR 1.25; CI 1.14-1.37), and renal disease (OR 1.31; CI 1.15-1.48) were associated with a higher risk of undergoing amputation without prior revascularisation.
The incidence of major amputations decreased, while general cardiovascular prevention and revascularisation rates increased. Despite that, few patients had revascularisation prior to amputation, leaving room for improvements.
本全国性研究旨在深入了解丹麦外周动脉疾病（PAD）患者血管服务和主要截肢的发生率和地域分布。
通过将人群健康和行政数据库的数据进行链接，调查由 PAD 引起的主要截肢的发生率。研究期间分为三个部分，即 1997-2002 年、2003-2008 年和 2009-2014 年。计算每 10 万≥50 岁居民的截肢率和再血管化率，并使用散点图显示关联。使用混合效应模型探讨截肢率和再血管化率之间的关联。使用多变量逻辑回归识别相对于有再血管化的截肢患者，无再血管化的截肢患者的风险因素。
在 1997-2014 年期间，进行了 13075 例首次主要截肢。糖尿病患者以及动脉粥样硬化合并症的比例在几十年中有所增加。发病率从 1997-2002 年的每 10 万≥50 岁公民 41.67 例降至 2009-2014 年的 32.53 例（r=-0.88，p<.001），但存在市级差异。与此同时，再血管化从 1997-2002 年的每 10 万≥50 岁公民 166.63 例增加到 2009-2014 年的 239.05 例（r=0.83，p<.001）。在截肢前一年内接受血管外科医生评估的患者比例从 23.7%增加到 31.3%（p<.001），而在截肢前一年内进行再血管化的患者比例没有增加。多变量逻辑回归分析表明，糖尿病（OR 1.28；95%CI 1.17-1.40）、中风（OR 1.66；95%CI 1.52-1.81）、冠心病（OR 1.25；95%CI 1.14-1.37）和肾脏疾病（OR 1.31；95%CI 1.15-1.48）与未经再血管化的截肢风险增加相关。
主要截肢的发生率下降，而一般心血管预防和再血管化率上升。尽管如此，仍有少数患者在截肢前进行了再血管化，因此仍有改进的空间。
