Epidemiology of first-time major lower extremity amputations- A Danish Nationwide cohort study from 2010 to 2021

Background and AimMajor lower extremity amputations (MLEA) are common procedures. Potential changes in surgical strategy and patient characteristics over time have not been described previously. The aim of this study was to investigate the incidence rates and surgical strategies of first-time MLEAs over time from 2010 to 2021. Furthermore, to describe patient demographics, and their changes in the same period.MethodsThis is an observational nationwide register study including all first-time MLEAs performed in patients >= 18 years from 2010 to 2021, with data from the Danish National Patient Register.ResultsA total of 12,672 first-time MLEA patients were identified from 2010 to 2021. The annual number of first-time MLEAs each year was unchanged at approx. 1000 annually during the study period. In 2021 the total incidence was 21.3/100,000 inhabitants and the total adjusted incidence rate decreased by 2.3% (95% CI 1.8-2.8) per year. The adjusted frequency of transfemoral amputations increased significantly with 10.9% each year confidence interval (CI) (9.7-12.0), whereas knee disarticulation(-19.4%/year CI (-22.2- -16.5)) and transtibial amputation (-7.3%/year CI (-8.5- -6.1)) significantly decreased. The frequency of primary hip disarticulations were stable throughout the study period (p-value 0.06). When analyzing patient comorbidity profiles we found no major changes over time. When statistically testing for time trends, only dyslipidemia (5.7%/year CI (4.5-7.1)), renal insufficiency (1.8%/year CI(0.2-3.3), peripheral artrial disease (-9.3%/year CI (-10.8- -7.7)) and cardiovascular disease (-3.4%/year CI(-4.6- -2.1)) showed a significant time trend in the study period.ConclusionsWe observed a decreasing incidence of first-time MLEA in Denmark and a shift towards increased use of transfemoral amputations as initial MLEA level. Investigation of the comorbidity profile of MLEA patients revealed some time trend changes during the study period, but with limited clinical relevance. Hence, the observed prominent shift towards a more proximal first time amputation level in Denmark did not seem to be associated with an altered comorbidity profile of these patients. Whether the change in surgical strategy is to the benefit of the patients should be investigated further.