Lopez-de-Andres Ana, Jimenez-Garcia Rodrigo, Hernandez-Barrera Valentin, de Miguel-Diez Javier, de Miguel-Yanes Jose M, Omaña-Palanco Ricardo, Carabantes-Alarcon David
Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28007 Madrid, Spain.
Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, 28032 Madrid, Spain.
J Clin Med. 2022 Feb 25;11(5):1246. doi: 10.3390/jcm11051246.
(1) Background: To examine trends in the incidence (2001-2019), clinical characteristics and in-hospital outcomes following major and minor non-traumatic lower-extremity amputations (LEAs) among people with type 2 diabetes mellitus (T2DM) in Spain, assessing possible sex differences. (2) Methods: Retrospective cohort study using data from the Spanish National Hospital Discharge Database. Joinpoint regression was used to estimate incidence trends, and multivariable logistic regression to estimate factors associated with in-hospital mortality (IHM). (3) Results: LEA was coded in 129,059 patients with T2DM (27.16% in women). Minor LEAs accounted for 59.72% of amputations, and major LEAs comprised 40.28%. The adjusted incidences of minor and major LEAs were higher in men than in women (IRR 3.51; 95%CI 3.46-3.57 and IRR 1.98; 95%CI 1.94-2.01, respectively). In women, joinpoint regression showed that age-adjusted incidence of minor LEAs remained stable over time, and for major LEAs, it decreased from 2006 to 2019. In men, incidences of minor and major LEAs decreased significantly from 2004 to 2019. In-hospital mortality (IHM) increased with age and the presence of comorbidity, such as heart failure (OR 5.11; 95%CI 4.61-5.68, for minor LEAs and OR 2.91; 95%CI 2.71-3.13 for major LEAs). Being a woman was associated with higher IHM after minor and major LEA (OR 1.3; 95%CI 1.17-1.44 and OR 1.18; 95%CI 1.11-1.26, respectively). (4) Conclusions: Our data showed major sex differences indicating decreasing and increasing LEA trends among men and women, respectively; furthermore, women presented significantly higher IHM after minor and major LEA procedures than men.
(1) 背景：为研究西班牙2型糖尿病（T2DM）患者中，大、小非创伤性下肢截肢（LEA）的发病率趋势（2001 - 2019年）、临床特征及住院结局，评估可能存在的性别差异。(2) 方法：采用西班牙国家医院出院数据库的数据进行回顾性队列研究。用Joinpoint回归估计发病率趋势，用多变量逻辑回归估计与住院死亡率（IHM）相关的因素。(3) 结果：129,059例T2DM患者被编码为LEA（女性占27.16%）。小LEA占截肢手术的59.72%，大LEA占40.28%。小LEA和大LEA的校正发病率男性高于女性（IRR分别为3.51；95%CI 3.46 - 3.57和IRR 1.98；95%CI 1.94 - 2.01）。在女性中，Joinpoint回归显示，年龄校正后的小LEA发病率随时间保持稳定，大LEA发病率从2006年到2019年有所下降。在男性中，小LEA和大LEA的发病率从2004年到2019年显著下降。住院死亡率（IHM）随年龄和合并症的出现而增加，如心力衰竭（小LEA的OR为5.11；95%CI 4.61 - 5.68，大LEA的OR为2.91；95%CI 2.71 - 3.13）。女性在小LEA和大LEA后与较高的IHM相关（OR分别为1.3；95%CI 1.17 - 1.44和OR 1.18；95%CI 1.11 - 1.26）。(4) 结论：我们的数据显示出明显的性别差异，表明男性和女性的LEA趋势分别呈下降和上升趋势；此外，女性在小LEA和大LEA手术后的IHM显著高于男性。
