Incidence of Lower Extremity Amputation in Romania: A Nationwide 5-Year Cohort Study, 2015-2019.

Background and Objectives: The primary objective of this study was to investigate the incidence of lower extremity amputations (LEAs) in a representative population from Romania, in both diabetic and non-diabetic adults, including trauma-related amputations. The secondary objective was to evaluate the trends in LEAs and the overall ratio of major-to-minor amputations. Material and Methods: The study was retrospective and included data from the Romanian National Hospital Discharge Records, conducted between 1 January 2015 and 31 December 2019. Results: The overall number of cases with LEAs was 88,102, out of which 38,590 were aterosclerosis-related LEAs, 40,499 were diabetes-related LEAs, and 9013 were trauma-related LEAs, with an ascending trend observed annually for each of these categories. Of the total non-traumatic amputations, 51.2% were in patients with diabetes. Most LEAs were in men. The total incidence increased from 80.61/100,000 in 2015 to 98.15/100,000 in 2019. Conclusions: Our study reported a 21% increase in total LEAs, 22.01% in non-traumatic LEAs, and 19.65% in trauma-related amputation. The minor-to-major amputation ratio increased over the study period in patients with diabetes. According to these findings, it is estimated that currently, in Romania, there is one diabetes-related amputation every hour and one non-traumatic amputation every 30 min.

Predictive value of a novel sub-item mortality risk score derived from the Norfolk Quality of Life in Diabetic Neuropathy questionnaire in Romanian participants with diabetes mellitus.

AIMS: To evaluate whether the Norfolk Quality of Life in Diabetic Neuropathy (QOL-DN) questionnaire and the novel Norfolk Mortality Risk Score (NMRS), comprising Norfolk QOL-DN items, can identify 4-year mortality risk in individuals with diabetes. METHODS: Of 21,756 adults completing Norfolk QOL-DN in 2012, two groups of surviving and deceased patients were identified in 2016: Group 1, from a county capital and Group 2, from six small cities. NMRS was calculated in Group 1 using the 2012 scores of Norfolk QOL-DN items that discriminate between deceased and surviving participants (p < 0.05) and was subsequently applied to Group 2. RESULTS: 763 participants were included (Group 1: 481 [450 surviving, 31 deceased]; Group 2: 282 [218 surviving, 64 deceased]). Total Norfolk QOL-DN score was significantly higher (worse) in deceased participants than in survivors in both groups (p ≤ 0.008). Optimal cut-off for the 25-item NMRS was 11.5 in Group 1. Individuals in Groups 1 and 2 with NMRS≥ 11.5 in 2012 had a 4-year mortality risk ratio of 4.24 (95 % confidence interval [CI]: 1.65-10.84) and 2.33 (95 % CI: 1.33-4.07), respectively, corresponding to 8 and 16 additional deaths/100 persons/4 years (p = 0.001). CONCLUSION: Norfolk QOL-DN and NMRS can identify individuals with diabetes at risk of 4-year mortality.

Factors influencing the quality of life over a 4-year period of time in Romanian patients with diabetes mellitus.

AIM: To evaluate the changes in quality of life (QOL), diabetic neuropathy (DN) and amputations over 4 years in patients with diabetes. METHODS: In 2012, 25,000 Romanian-translated Norfolk QOL-DN self-administered questionnaires were distributed during a cross-sectional study. Between March-December 2016, all patients identified from the 2012 cohort and enrolled in this follow-up study completed the Norfolk QOL-DN questionnaire; amputations suffered since 2012 were recorded. The influence of age and duration of diabetes (DD) on delta QOL scores (defined as the differences between 2012 and 2016 scores) and of sex, age, diabetes type, DD and declared DN on amputations was explored using multivariate linear and logistic regression, respectively. RESULTS: The mean (standard deviation) age of the 1865 participants was 60.6 (10.3) years. Mean total QOL-DN score increased from 2012 to 2016 by 4.39% (P = .079). Both DD (b = 0.39, 95% confidence interval [CI] 0.21-0.57, P < .001) and age (b = 0.25, 95% CI 0.13-0.36, P < .001) were significantly correlated with total QOL-DN score. Delta total QOL was higher in patients whose statement about having DN changed since 2012. Over 4 years, 36 patients suffered amputations. Male sex (OR = 3.11, 95% CI 1.46-6.62, P = .003), physical functioning/large-fibre neuropathy subscale score (OR = 1.04, 95% CI 1.001-1.09, P = .047), autonomic neuropathy subscale score (OR = 0.78, 95% CI 0.64-0.94, P = .011) and small-fibre neuropathy subscale score (OR = 1.21, 95% CI 1.05-1.40, P = .007) were significant predictors of amputations. Delta total QOL-DN score was 10 times higher in patients who suffered amputation(s) compared with their amputation-free counterparts. CONCLUSION: QOL deteriorates with age and DD. Norfolk QOL-DN subscale scores can predict amputations.