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Sustained reduction in major amputations in diabetic patients - 628 amputations in 461 patients in a defined population over a 20-year period

  • Jan Larsson
  • Magnus Eneroth
  • Jan Apelqvist
  • Anders Stenström
Publishing year: 2008
Language: English
Pages: 665-673
Publication/Series: Acta Orthopaedica
Volume: 79
Issue: 5
Document type: Journal article
Publisher: Taylor & Francis

Abstract english

Background and purpose With an ageing population and an increasing incidence of diabetes, reduction of the number of diabetes-related amputations becomes increasingly difficult to achieve and maintain. There is controversy in this respect regarding the degree of success. We started a multidisciplinary treatment program for diabetic foot ulcers in 1982, and have now assessed incidence rates of amputations from 1982 through 2001. Methods In a defined population, gradually increasing from 199,000 to 234,000, all diabetes-related amputations of the lower extremity from toe to hip were recorded from January 1, 1982 to December 31, 2001, using several sources of information. Results The incidence of major amputations decreased by 0.57 from 16 (11-22) to 6.8 (6.1-7.5) per 100,000 inhabitants between the first and last 4-year period. The most substantial decrease was seen in patients aged 80 years and older. The fraction of amputations with a final level at or below the ankle (n = 240) increased from 0.23 in the first 4-year period to 0.31, 0.49, 0.47, and 0.49 in the following 4-year periods. The overall fraction of re-amputation was 0.34 in the first 4-year period and 0.27, 0.21, 0.32, and 0.21 in the following 4-year periods. The fraction of amputations in diabetic patients that were channeled through the footcare team prior to amputation increased from 0.51 in the first 4-year period to 0.83, 0.86, 0.90, and 0.90 in the following 4-year periods. Interpretation Our findings indicate that a substantial decrease in the incidence of major lower extremity amputations in diabetic patients has been achieved and maintained.


  • Orthopedics
  • Leg: surgery
  • Diabetic Foot: surgery
  • Sweden: epidemiology
  • Diabetic Foot: prevention & control
  • Amputation: statistics & numerical data
  • Diabetic Foot: epidemiology


  • Genomics, Diabetes and Endocrinology
  • ISSN: 1745-3682
E-mail: jan [dot] apelqvist [at] med [dot] lu [dot] se


Genomics, Diabetes and Endocrinology

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Lund University Diabetes Centre, CRC, SUS Malmö, Jan Waldenströms gata 35, House 91:12. SE-214 28 Malmö. Telephone: +46 40 39 10 00