Study reveals concerning trends in lower limb amputations related to peripheral arterial disease

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Concerning trends and regional disparities for patients having lower limb amputations related to peripheral arterial disease, have been revealed in a new study.

Amputation rates in the North of England are the highest in the country with mortality rates within 90 days of amputation also higher in the North, the Midlands and London.

Patients in the North are also more likely to have above, rather than below, knee amputation which has an increased chance of complications and mortality.

The new study, led by researchers from the University of Sheffield and funded by the National Institute for Health and Care Research (NIHR), highlights the urgent need to improve care and prevention strategies, especially for people with diabetes. It also emphasizes the urgent need to address persisting regional disparities in healthcare access and outcomes.

Peripheral arterial disease, which is caused by a build-up of fatty deposits in the arteries to the legs, restricts blood supply and can be a debilitating condition. Major amputation of the lower limb is reserved as a treatment of last resort when other options do not exist or have failed.

Being told you need to have a leg amputated can be a devastating and frightening experience for patients and adjusting to life after amputation can be challenging.

Healthcare professionals and policymakers must renew their commitment to combating peripheral arterial disease and its devastating consequences.

While some progress has been made, the study emphasizes the urgent need to address the glaring regional disparities in healthcare access and outcomes.

Professor Ravi Maheswaran, Professor of Epidemiology and Public Health at the University of Sheffield's School of Medicine and Population Health

Researchers at the University of Sheffield analyzed hospital admissions and census area data over a 12-year period from 2006 to 2018. During the study period there were a total of 47,249 major lower limb amputations due to peripheral arterial disease, resulting in an annual amputation rate of 11 per 100,000 individuals aged 25 and over.

These rates were notably higher among men and substantially higher in people with diabetes.

For patients undergoing above knee amputation, 25.3 per cent had died within 90 days of the operation, compared with 11.9 per cent for below the knee amputation.

Encouragingly, the study did reveal a decrease in amputation rates over time, particularly in the population with diabetes. Mortality within 90 days of amputation also exhibited a decline over the study period, while the percentage of patients with previous repair of arteries in the legs to try and
avoid amputation also generally increased.

Source:
Journal reference:

Maheswaran, R., et al. (2024). Time trends and geographical variation in major lower limb amputation related to peripheral arterial disease in England. BJS Open. doi.org/10.1093/bjsopen/zrad140.

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