Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA
Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA.
Diabetes Care. 2020 May;43(5):1033-1040. doi: 10.2337/dc19-2337. Epub 2020 Mar 11.
To assess whether the risk of subsequent lower-limb amputations and death following an initial toe amputation among individuals with diabetes has changed over time and varies by demographic characteristics and geographic region.
Using Veterans Health Administration (VHA) electronic medical records from 1 October 2004 to 30 September 2016, we determined risk of subsequent ipsilateral minor and major amputation within 1 year after an initial toe/ray amputation among veterans with diabetes. To assess changes in the annual rate of subsequent amputation over time, we estimated age-adjusted incidence of minor and major subsequent ipsilateral amputation for each year, separately for African Americans (AAs) and whites. Geographic variation was assessed across VHA markets ( = 89) using log-linear Poisson regression models adjusting for age and ethnoracial category.
Among 17,786 individuals who had an initial toe amputation, 34% had another amputation on the same limb within 1 year, including 10% who had a major ipsilateral amputation. Median time to subsequent ipsilateral amputation (minor or major) was 36 days. One-year risk of subsequent major amputation decreased over time, but risk of subsequent minor amputation did not. Risk of subsequent major ipsilateral amputation was higher in AAs than whites. After adjusting for age and ethnoracial category, 1-year risk of major subsequent amputation varied fivefold across VHA markets.
Nearly one-third of individuals require reamputation following an initial toe amputation, although risks of subsequent major ipsilateral amputation have decreased over time. Nevertheless, risks remain particularly high for AAs and vary substantially geographically.
评估糖尿病患者初次脚趾截肢后，后续下肢截肢和死亡的风险是否随时间而变化，以及这种变化是否因人口统计学特征和地理位置而异。
利用退伍军人健康管理局（VHA）2004 年 10 月 1 日至 2016 年 9 月 30 日的电子病历，我们确定了糖尿病患者初次脚趾/跖骨截肢后 1 年内同侧小截肢和大截肢的风险。为了评估后续截肢的年发生率随时间的变化，我们分别估计了每个年份非裔美国人（AA）和白人小截肢和大截肢的年龄调整后的发生率。利用对数线性泊松回归模型，通过年龄和种族类别调整，评估了退伍军人健康管理局市场（ = 89）之间的地理差异。
在 17786 例初次脚趾截肢患者中，34%在 1 年内同侧肢体再次截肢，其中 10%发生同侧大截肢。同侧再次截肢（小或大）的中位时间为 36 天。1 年内同侧大截肢的风险随时间降低，但小截肢的风险没有降低。AA 人群同侧大截肢的风险高于白人。在调整年龄和种族类别后，退伍军人健康管理局市场之间 1 年内同侧大截肢的风险差异高达五倍。
近三分之一的患者初次脚趾截肢后需要再次截肢，尽管同侧大截肢的风险随时间降低。尽管如此，AA 的风险仍然特别高，且在地理上差异很大。
