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Lower limb amputations in Trondheim, Norway
Eivind Witsø1, Arne Lium, Stian Lydersen
1Department of Orthopaedic Surgery, St. Olav's University Hospital, Norway. eivind.witso@stolav.no
Insights
A diabetic foot team in Trondheim reduced lower-limb amputations (LLAs) by improving care for diabetic foot complications. This initiative led to a significant decrease in diabetic LLAs over a decade.
Area of Science:
- Vascular Surgery
- Diabetology
- Public Health
Background:
- Diabetic lower-limb amputations (LLAs) represented one-third of all LLAs in Trondheim.
- A dedicated diabetic foot team was established in 1996 to address this high rate.
Purpose of the Study:
- To evaluate the incidence of LLAs in Trondheim 10 years after the establishment of a diabetic foot team.
- To assess the impact of the diabetic foot team on reducing diabetic-related lower-limb amputations.
Main Methods:
- Retrospective analysis of LLAs performed in Trondheim during 2004-2007, compared to 1994-1997 data.
- Registration of diabetic foot team activities (1996-2006) and vascular procedures (1998-2006).
Main Results:
- A decrease in non-traumatic LLAs was observed between the two 3-year periods.
- The incidence of diabetic major LLAs per 10³ diabetics per year decreased from 4.0 to 2.4.
- LLAs in patients with peripheral vascular disease decreased from 18 to 12 per 10⁵ inhabitants per year.
Conclusions:
- A reduction in vascular obstructive lower-limb disease was noted in Trondheim.
- The decline in diabetic LLAs is attributed to improved diabetic foot care and management.
Background And Purpose:
In the city of Trondheim, Norway, diabetic lower-limb amputations accounted for one-third of all lower-limb amputations (LLAs). In an attempt to reduce this rate, a diabetic foot team was established in 1996. We present the incidence of LLA in Trondheim as measured 10 years later.
Patients And Methods:
In 2004-07, we registered all LLAs performed in Trondheim and then compared the data with previously published data from 1994-1997. From 1996 through 2006, we registered the activity of the diabetic foot team and we also registered the number of vascular procedures performed on citizens of Trondheim from 1998 through 2006.
Results:
Comparing the two 3-year periods 1994-97 and 2004-07, we observed a decrease in all non-traumatic LLAs. The incidence of diabetic major LLAs per 10³ diabetics per year decreased from 4.0 to 2.4, and in patients with peripheral vascular disease we observed a decrease in LLAs from 18 to 12 per 10⁵ inhabitants per year. 5,915 consultations on diabetic subjects were conducted by the diabetic foot team during the period 1996-2006. From 1998 to 2006, the rate of vascular procedures decreased in the non-diabetic population, and was unchanged in diabetic subjects.
Interpretation:
In the population of Trondheim city there appears to have been a reduction in the rate of vascular obstructive lower-limb disease between the two 3-year periods 1994-97 and 2004-07. In our judgment, the decline in diabetic LLA also reflects better care of the diabetic foot.
