scholarly journals Temporal Trends in Lower-Limb Major and Minor Amputation and Revascularization Procedures in People With Diabetes in England During the COVID-19 Pandemic

Diabetes Care ◽  
2021 ◽  
pp. dc202852
Author(s):  
Jonathan Valabhji ◽  
Emma Barron ◽  
Eszter P. Vamos ◽  
Ketan Dhatariya ◽  
Frances Game ◽  
...  
Keyword(s):  
Lower Limb ◽  
Temporal Trends ◽  
Minor Amputation ◽  
Revascularization Procedures

scholarly journals Trends in Digital Replantation: 10 Years of Experience at a Large Canadian Tertiary Care Center

2020 ◽  
pp. 229255032092591
Author(s):  
Ogi Solaja ◽  
Helene Retrouvey ◽  
Heather Baltzer
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Temporal Trends ◽  
Workplace Safety ◽  
Injury Characteristics ◽  
Number Of Patients ◽  
Significant Downward Trend ◽  
Revascularization Procedures ◽  
American Authors ◽  
Digital Replantation

Background: Since 1965, the practice of digital replantation has seen great technical strides and become commonplace worldwide. However, some American authors have recently reported declining rates of replantation. We set out to characterize the patient population and describe treatment patterns from 2005 to 2016 at a large Canadian regional replantation center. Methods: A retrospective cohort of all patients undergoing digital replantation and revascularization from 2005 to 2016 was identified. Data were collected on demographics, injuries, procedures, and outcomes. Descriptive statistics were performed, followed by a comparison of two 5-year periods to evaluate temporal trends. Results: A total of 234 patients were treated with 146 replantation and 204 revascularization procedures. Patients were largely male, healthy, and worked as manual labourers. Overall, the failure rate of individual repairs was 28.7%. Over time, there was a trend toward more crush or avulsion and multidigit injuries, and surgeries performed after 2011 were significantly longer. There was a significant downward trend in the number of patients treated at our center each year. Additionally, there was a statistically significant decrease in the proportion of replanted to revised digits in multidigit cases. Discussion: Our observation of declining replantation rates is in line with recent American observations. The reason for this is not obvious but may represent a change in injury characteristics or surgeon attitudes. Conclusion: We suspect that these changes represent a change in workplace safety and injury characteristics, but further studies are needed to assess patient and surgeon treatment decisions.

scholarly journals What happens to our amputees? The Darling Downs experience

2020 ◽  
Vol 28 (3) ◽  
pp. 230949902095847
Author(s):  
Varun Vasudeva ◽  
Adam Parr ◽  
Alan Loch ◽  
Chris Wall
Keyword(s):  
Lower Limb ◽  
Treatment Options ◽  
Major Amputation ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Mortality Data ◽  
Minor Amputation ◽  
Poor Outcomes ◽  
American Society ◽  
End Stage

Background: Major lower limb amputation is occasionally required in the management of end-stage pathology where other treatment options have failed. The primary aim of this study was to determine the 30-day and 1-year mortality rates of patients undergoing nontraumatic major lower limb amputation. Secondary aims were to investigate risk factors for poor outcomes, incidence of previous minor amputation, and the rate of subsequent major amputation. Methods: All nontraumatic, major lower limb amputations performed at Toowoomba Hospital during an 18-year period were retrospectively reviewed. Mortality data were obtained from the Queensland Registry of Births, Deaths and Marriages. Kaplan–Meier analysis was performed to determine survival after amputation. Results: A total of 147 patients were included in the study, with 104 undergoing below knee and 43 undergoing above knee amputations. Ten patients identified as having an Aboriginal and Torres Strait Islander background. For all patients, the 30-day mortality was 4.1% and 1-year mortality was 21.1%. For Indigenous patients, 30-day mortality was 10%. Previous minor amputation had occurred in 40 patients. Twenty-nine patients underwent further minor surgery after their initial major amputation, with thirteen requiring subsequent major amputation. Factors that increased mortality risk were the presence of peripheral vascular disease, an American Society of Anesthesiologists score of four and age greater than 65 years. Conclusion: The morbidity and mortality following major lower limb amputation is significant. The findings of this study highlight the importance of preventative measures to minimize the incidence of lower limb amputations in the future.

scholarly journals Foot Revascularization Avoids Major Amputation in Persons with Diabetes and Ischaemic Foot Ulcers

2021 ◽  
Vol 10 (17) ◽  
pp. 3977
Author(s):  
Marco Meloni ◽  
Daniele Morosetti ◽  
Laura Giurato ◽  
Matteo Stefanini ◽  
Giorgio Loreni ◽  
...  
Keyword(s):  
Independent Predictor ◽  
Arterial Disease ◽  
Major Amputation ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Minor Amputation ◽  
The Mean ◽  
Revascularization Procedures

The study aims to evaluate the effectiveness of foot revascularization in persons with diabetic foot ulcers (DFUs) and below-the-ankle (BTA) arterial disease. Consecutive patients referred for a new active ischaemic DFU requiring lower limb revascularization were considered. Among those, only patients with a BTA arterial disease were included. Revascularization procedures were retrospectively analysed: in the case of successful foot revascularization (recanalization of pedal artery, or plantar arteries or both) or not, patients were respectively divided in two groups, successful foot perfusion (SFP) and failed foot perfusion (FFP). Healing, minor and major amputation at 12 months of follow-up were evaluated and compared. Eighty patients (80) were included. The mean age was 70.5 ± 10.9 years, 55 (68.7%) were male, 72 (90%) were affected by type 2 diabetes with a mean duration of 22.7 ± 11.3 years. Overall 45 (56.2%) patients healed, 47 (58.7%) had minor amputation and 13 (16.2%) major amputation. Outcomes for SFP and FFP were respectively: healing (89.3 vs. 9.1%, p < 0.0001), minor amputation (44.7 vs. 78.8%, p = 0.0001), major amputation (2.1 vs. 36.3%, p < 0.0001). Failed foot revascularization resulted an independent predictor of non-healing, minor amputation, and major amputation. Foot revascularization is mandatory to achieve healing and avoid major amputation in persons with ischaemic DFU and BTA arterial disease.

scholarly journals Incidence of lower limb amputation in people with and without diabetes: a nationwide 5-year cohort study in Japan

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e048436
Author(s):  
Fumika Kamitani ◽  
Yuichi Nishioka ◽  
Tatsuya Noda ◽  
Tomoya Myojin ◽  
Shinichiro Kubo ◽  
...  
Keyword(s):  
Cohort Study ◽  
Lower Limb ◽  
Time Trend ◽  
Major Amputation ◽  
Significant Decline ◽  
Lower Limb Amputation ◽  
Amputation Rate ◽  
Limb Amputation ◽  
National Healthcare ◽  
Minor Amputation

IntroductionThis study was conducted to investigate the incidence and time trend of lower limb amputation (LLA) among people with and without diabetes.Research design and methodsThis retrospective population-based cohort study was based on the national claims data in Japan, comprising a total population of 150 million. Data of all individuals who had LLA from April 2013 to March 2018 were obtained. We analysed the sex-adjusted and age-adjusted annual LLA rate (every fiscal year) in people with and without diabetes for major and minor amputation. To test for time trend, Poisson regression models were fitted.ResultsIn the 5-year period, 30 187 major and 29 299 minor LLAs were performed in Japan. The sex-adjusted and age-adjusted incidence of major and minor LLAs was 9.5 (people with diabetes, 21.8 vs people without diabetes, 2.3, per 100 000 person-years) and 14.9 (people with diabetes, 28.4 vs people without diabetes, 1.9, per 100 000 person-years) times higher, respectively, in people with diabetes compared with those without. A significant decline in the annual major amputation rate was observed (p<0.05) and the annual minor amputation rate remained stable (p=0.63) when sex, age and people with and without diabetes were included as dependent variables.ConclusionsThis is the first report of the national statistics of LLAs in Japan. The incidence of major and minor LLAs was 10 and 15 times higher, respectively, in people with diabetes compared with those without. A significant decline in the major amputation rate was observed, and the annual minor amputation rate remained stable during the observation period. This information can help to create an effective national healthcare strategy for preventing limb amputations, which affect the quality of life of patients with diabetes and add to the national healthcare expenditure.

Identification of risk factors for ipsilateral lower limb loss after minor amputation

2015 ◽  
Vol 7 (3) ◽  
pp. 168-172
Author(s):  
Ayana Sasaki ◽  
Hisae Hayashi ◽  
Haruto Yamazaki ◽  
Morio Kawamura ◽  
Eriko Kondo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lower Limb ◽  
Limb Loss ◽  
Minor Amputation

scholarly journals TEMPORAL TRENDS AND COMPLICATIONS ASSOCIATED WITH LOWER LIMB REVASCULARIZATION IN PATIENTS ON DIALYSIS

2016 ◽  
Vol 67 (13) ◽  
pp. 2309
Author(s):  
Pranav Sandilya Garimella ◽  
Poojitha Balakrishnan ◽  
Narender Annapureddy ◽  
Achint Patel ◽  
Shanti Patel ◽  
...  
Keyword(s):  
Lower Limb ◽  
Temporal Trends

Calcium Score Predicts Mortality After Revascularization in Critical Limb Ischemia

2021 ◽  
pp. 152660282110599
Author(s):  
Adalberto Megale ◽  
Nelson Wolosker ◽  
Vitória Kalil ◽  
João Nigro ◽  
Carolina Wakisaka ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lower Limb ◽  
Calcium Score ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Lower Limbs ◽  
Total Calcium ◽  
Technical Success ◽  
Peripheral Arterial ◽  
Revascularization Procedures

Purpose: The calcium score is a measure of vessel wall calcification and has clinical applications when studied in different vascular beds. The presence of vascular calcification in the arteries of the lower limbs is very common in patients with peripheral arterial disease; however, its relationship with the postoperative outcomes in patients undergoing lower limb revascularization is still poorly studied. The aim of this study is to evaluate association between the calcium score of lower limbs and the postoperative outcomes in patients with peripheral arterial disease undergoing revascularization procedures. Methodology: We retrospectively analyzed 88 lower limb revascularization procedures in 72 patients with critical limb ischemia who had enhanced computed tomography for preoperative evaluation. The calcium score was calculated, from the angiographic phase of preoperative computed tomography, in the segments of the aorta, iliac, femoropopliteal, and infrapopliteal. It was also calculated the calcium score of the operated limb, and the total calcium score using a standardized method. The outcomes evaluated were the occurrence of acute myocardial infarction, amputation, patency, technical success, and death from any cause. Patients were followed up through a 12 month period. Results: Among the 88 procedures performed, 31 (43.1%) lesions were classified as Trans-Atlantic Inter-Society Consensus Document II D. There were 66 (75%) endovascular procedures, 16 (18.2%) open surgery, and 6 (6.8%) hybrid interventions. No statistically significant relationship was found between the calcium score of the segments (aorta, iliac, femoropopliteal, infrapopliteal, the operated limb, and total calcium score) and the outcomes of acute myocardial infarction, amputation, patency, and technical success in any of the periods analyzed. The calcium score of the operated limb was higher in patients who died within 30 days and 6 months (6571 vs 2590.6; p=0.026) and (5227.8 vs 2335.3; p=0.036). Conclusion: A standardized calcium score calculation method with the angiographic phase of the computed tomography is feasible and reproducible. Higher values of the calcifications of the operated limb are related to a greater chance of death in the postoperative period. The calcium score of the operated limb can be considered as a marker of clinical severity and prognosis in this group of patients

scholarly journals Complications in Patients with Acute Myocardial Infarction Supported with Extracorporeal Membrane Oxygenation

2020 ◽  
Vol 9 (3) ◽  
pp. 839 ◽  
Author(s):  
Saraschandra Vallabhajosyula ◽  
Malcolm R. Bell ◽  
Gurpreet S. Sandhu ◽  
Allan S. Jaffe ◽  
David R. Holmes ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Lower Limb ◽  
Temporal Trends ◽  
Ecmo Support ◽  
Limb Amputation ◽  
Membrane Oxygenation ◽  
Hospitalization Costs

Background: There are limited data on complications in acute myocardial infarction (AMI) admissions receiving extracorporeal membrane oxygenation (ECMO). Methods: Adult (>18 years) admissions with AMI receiving ECMO support were identified from the National Inpatient Sample database between 2000 and 2016. Complications were classified as vascular, lower limb amputation, hematologic, and neurologic. Outcomes of interest included temporal trends, in-hospital mortality, hospitalization costs, and length of stay. Results: In this 17-year period, in ~10 million AMI admissions, ECMO support was used in 4608 admissions (<0.01%)—mean age 59.5 ± 11.0 years, 75.7% men, 58.9% white race. Median time to ECMO placement was 1 (interquartile range [IQR] 0–3) day. Complications were noted in 2571 (55.8%) admissions—vascular 6.1%, lower limb amputations 1.1%, hematologic 49.3%, and neurologic 9.9%. There was a steady increase in overall complications during the study period (21.1% in 2000 vs. 70.5% in 2016). The cohort with complications, compared to those without complications, had comparable adjusted in-hospital mortality (60.7% vs. 54.0%; adjusted odds ratio 0.89 [95% confidence interval 0.77–1.02]; p = 0.10) but longer median hospital stay (12 [IQR 5–24] vs. 7 [IQR 3–21] days), higher median hospitalization costs ($458,954 [IQR 260,522–737,871] vs. 302,255 [IQR 173,033–623,660]), fewer discharges to home (14.7% vs. 17.9%), and higher discharges to skilled nursing facilities (44.1% vs. 33.9%) (all p < 0.001). Conclusions: Over half of all AMI admissions receiving ECMO support develop one or more severe complications. Complications were associated with higher resource utilization during and after the index hospitalization.

scholarly journals Gradual decline in mobility with the adoption of food production in Europe

2015 ◽  
Vol 112 (23) ◽  
pp. 7147-7152 ◽  
Author(s):  
Christopher B. Ruff ◽  
Brigitte Holt ◽  
Markku Niskanen ◽  
Vladimir Sladek ◽  
Margit Berner ◽  
...  
Keyword(s):  
Bone Strength ◽  
Lower Limb ◽  
Food Production ◽  
Bending Strength ◽  
Temporal Trends ◽  
Activity Level ◽  
Population History ◽  
Upper Paleolithic ◽  
Limb Bones ◽  
Skeletal Robusticity

Increased sedentism during the Holocene has been proposed as a major cause of decreased skeletal robusticity (bone strength relative to body size) in modern humans. When and why declining mobility occurred has profound implications for reconstructing past population history and health, but it has proven difficult to characterize archaeologically. In this study we evaluate temporal trends in relative strength of the upper and lower limb bones in a sample of 1,842 individuals from across Europe extending from the Upper Paleolithic [11,000–33,000 calibrated years (Cal y) B.P.] through the 20th century. A large decline in anteroposterior bending strength of the femur and tibia occurs beginning in the Neolithic (∼4,000–7,000 Cal y B.P.) and continues through the Iron/Roman period (∼2,000 Cal y B.P.), with no subsequent directional change. Declines in mediolateral bending strength of the lower limb bones and strength of the humerus are much smaller and less consistent. Together these results strongly implicate declining mobility as the specific behavioral factor underlying these changes. Mobility levels first declined at the onset of food production, but the transition to a more sedentary lifestyle was gradual, extending through later agricultural intensification. This finding only partially supports models that tie increased sedentism to a relatively abrupt Neolithic Demographic Transition in Europe. The lack of subsequent change in relative bone strength indicates that increasing mechanization and urbanization had only relatively small effects on skeletal robusticity, suggesting that moderate changes in activity level are not sufficient stimuli for bone deposition or resorption.

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