Risk of Ipsilateral Reamputation Following an Incident Toe Amputation Among US Military Veterans With Diabetes, 2005-2016
Risk of Ipsilateral Reamputation Following an Incident Toe Amputation Among US Military Veterans With Diabetes, 2005-2016
复制标题
DOI：
10.2337/dc19-2337
复制
发表时间：
2020-05-01
期刊：
影响因子：
16.2
通讯作者：
Boyko, Edward J.
中科院分区：
文献类型：
--
作者：
Littman, Alyson J.;Tseng, Chin-Lin;Boyko, Edward J.
目的评估糖尿病患者初次脚趾截肢后后续下肢截肢和死亡的风险是否随时间而变化，并因人口统计学特征和地理区域而异。研究设计和方法使用退伍军人健康管理局（VHA）2004年10月1日至2016年9月30日的电子病历，我们确定了糖尿病退伍军人首次脚趾/射线截肢后1年内随后同侧小截肢和大截肢的风险。为了评估随后截肢的年发生率随时间的变化，我们分别对非裔美国人（AAs）和白人估计了每年轻微和重大随后同侧截肢的年龄调整发生率。使用对数线性Poisson回归模型对VHA市场（n = 89）的地理差异进行了评估，该模型调整了年龄和种族类别。结果：在17,786例初次脚趾截肢的患者中，34%的患者在1年内在同一肢体上进行了另一次截肢，其中10%的患者进行了同侧大截肢。至随后同侧截肢（轻微或严重）的中位时间为36天。一年后大截肢的风险随着时间的推移而降低，但随后小截肢的风险没有降低。AA患者随后发生同侧大截肢的风险高于白人。在调整年龄和种族分类后，VHA市场中随后重大截肢的1年风险变化了5倍。近三分之一的人在初次脚趾截肢后需要再次截肢，尽管随着时间的推移，随后的同侧大截肢的风险已经降低。然而，AA的风险仍然特别高，并且在地理上存在很大差异。
OBJECTIVE To assess whether the risk of subsequent lower-limb amputations and death following an initial toe amputation among individuals with diabetes has changed over time and varies by demographic characteristics and geographic region. RESEARCH DESIGN AND METHODS Using Veterans Health Administration (VHA) electronic medical records from 1 October 2004 to 30 September 2016, we determined risk of subsequent ipsilateral minor and major amputation within 1 year after an initial toe/ray amputation among veterans with diabetes. To assess changes in the annual rate of subsequent amputation over time, we estimated age-adjusted incidence of minor and major subsequent ipsilateral amputation for each year, separately for African Americans (AAs) and whites. Geographic variation was assessed across VHA markets (n = 89) using log-linear Poisson regression models adjusting for age and ethnoracial category. RESULTS Among 17,786 individuals who had an initial toe amputation, 34% had another amputation on the same limb within 1 year, including 10% who had a major ipsilateral amputation. Median time to subsequent ipsilateral amputation (minor or major) was 36 days. One-year risk of subsequent major amputation decreased over time, but risk of subsequent minor amputation did not. Risk of subsequent major ipsilateral amputation was higher in AAs than whites. After adjusting for age and ethnoracial category, 1-year risk of major subsequent amputation varied fivefold across VHA markets. CONCLUSIONS Nearly one-third of individuals require reamputation following an initial toe amputation, although risks of subsequent major ipsilateral amputation have decreased over time. Nevertheless, risks remain particularly high for AAs and vary substantially geographically.