METHODS: We conducted a 12-consecutive-year observational study using Oklahoma\'s hospital discharge data. Discharges among patients 20 years or older with a primary or secondary diagnosis of diabetes and/or PAD were included. Diagnoses and amputation procedures were identified using International Classification of Disease-9 and -10 codes. Amputation rates were calculated per 1000 discharges. Trends in amputation rates were measured by annual percentage changes (APC). Prevalence ratios evaluated the differences in amputation rates across demographic groups.
RESULTS: Over 5,000,000 discharges were identified from 2008 to 2019. Twenty-four percent had a diagnosis of diabetes and/or PAD. The overall amputation rate was 12 per 1000 discharges for those with diabetes and/or PAD. Diabetes and/or PAD-related amputation rates increased from 8.1 to 16.2 (APC, 6.0; 95% confidence interval [CI], 4.7-7.3). Most amputations were minor (59.5%), and although minor, increased at a faster rate compared with major amputations (minor amputation APC, 8.1; 95% CI, 6.7-9.6 vs major amputation APC, 3.1; 95% CI, 1.5-4.7); major amputations were notable in that they were significantly increasing. Amputation rates were the highest among males (16.7), American Indians (19.2), uninsured (21.2), non-married patients (12.7), and patients between 45 and 49 years of age (18.8), and calculated prevalence ratios for each were significant (P = .001) when compared within their respective category.
CONCLUSIONS: Amputation rates in Oklahoma have nearly doubled in 12 years, with both major and minor amputations significantly increasing. This study describes a worsening trend, underscoring that amputations due to chronic disease is an urgent statewide health care problem. We also present imperative examples of amputation health care disparities. By defining these state-specific areas and populations at risk, we have identified areas to pursue and improve care. These distinctive risk factors will help to frame a statewide limb preservation intervention.
方法:我们使用俄克拉荷马州的出院数据进行了一项连续12年的观察性研究。包括患有糖尿病和/或PAD的主要或次要诊断的20岁或以上的患者的出院。使用ICD-9和ICD-10代码识别诊断和截肢程序。每1000次出院计算截肢率。截肢率的趋势是通过年度百分比变化(APC)来衡量的。患病率比评估了人口统计学组截肢率的差异。
结果:从2008-2019年确定了超过5,000,000个排放。24%的人被诊断为糖尿病和/或PAD。糖尿病和/或PAD患者的总截肢率为12/千次出院。糖尿病和/或PAD相关的截肢率从8.1增加到16.2(APC:6.0,95%CI:4.7-7.3)。大多数截肢是轻微的(59.5%),尽管未成年人与主要患者相比以更快的速度增加(未成年人截肢APC:8.1,95%CI:6.7-9.6vs.大截肢APC:3.1,95%CI:1.5-4.7),主要截肢的显著增加。截肢率在男性中最高(16.7),美洲印第安人(19.2)无保险(21.2),未婚患者(12.7),以及年龄在45至49岁(18.8岁)之间的患者,和计算出的患病率比在各自类别内进行比较时,均有显著意义(p=0.001).
结论:俄克拉荷马州的截肢率在12年内几乎翻了一番,主要和次要截肢都显着增加。这项研究描述了一种恶化的趋势,强调由于慢性疾病造成的截肢是一个紧迫的全州医疗保健问题。我们还提出了截肢医疗保健差距的重要例子。通过定义这些特定州的地区和处于危险中的人群,我们已经确定了追求和改善护理的领域。这些独特的风险因素将有助于制定全州范围内的肢体保留干预措施。