Analysis of Oklahoma amputation trends and identification of risk factors to target areas for limb preservation interventions.

OBJECTIVE: Annual trends of lower extremity amputation due to end-stage chronic disease are on the rise in the United States. These amputations are leading to massive expenses for patients and the medical system. In Oklahoma, we have a high-risk population because access to care is low, the number of uninsured is high, cardiovascular health is poor, and our overall health care performance is ranked 50th in the country. But we know little about Oklahomans and their risk of limb loss. It is, therefore, imperative to look closely at this population to discover contemporary rates, trends, and state-specific risk factors for amputation due to diabetes and/or peripheral arterial disease (PAD). We hypothesize that state-specific groups will be identified as having the highest risk for limb loss and that contemporary trends in amputations are rising. To create implementable solutions to limb preservation, a baseline must be set. METHODS: We conducted a 12-consecutive-year observational study using Oklahoma's hospital discharge data. Discharges among patients 20 years or older with a primary or secondary diagnosis of diabetes and/or PAD were included. Diagnoses and amputation procedures were identified using International Classification of Disease-9 and -10 codes. Amputation rates were calculated per 1000 discharges. Trends in amputation rates were measured by annual percentage changes (APC). Prevalence ratios evaluated the differences in amputation rates across demographic groups. RESULTS: Over 5,000,000 discharges were identified from 2008 to 2019. Twenty-four percent had a diagnosis of diabetes and/or PAD. The overall amputation rate was 12 per 1000 discharges for those with diabetes and/or PAD. Diabetes and/or PAD-related amputation rates increased from 8.1 to 16.2 (APC, 6.0; 95% confidence interval [CI], 4.7-7.3). Most amputations were minor (59.5%), and although minor, increased at a faster rate compared with major amputations (minor amputation APC, 8.1; 95% CI, 6.7-9.6 vs major amputation APC, 3.1; 95% CI, 1.5-4.7); major amputations were notable in that they were significantly increasing. Amputation rates were the highest among males (16.7), American Indians (19.2), uninsured (21.2), non-married patients (12.7), and patients between 45 and 49 years of age (18.8), and calculated prevalence ratios for each were significant (P = .001) when compared within their respective category. CONCLUSIONS: Amputation rates in Oklahoma have nearly doubled in 12 years, with both major and minor amputations significantly increasing. This study describes a worsening trend, underscoring that amputations due to chronic disease is an urgent statewide health care problem. We also present imperative examples of amputation health care disparities. By defining these state-specific areas and populations at risk, we have identified areas to pursue and improve care. These distinctive risk factors will help to frame a statewide limb preservation intervention.

Causas de cirugía de revisión en artroplastia total de cadera. Análisis epidemiológico retrospectivo / Causes for revision surgery in total hip replacement. A retrospective epidemiological analysis

Objetivo. Se pretende evaluar la incidencia de cada una de las causas de cirugía de revisión de artroplastia total de cadera en el periodo comprendido entre 2009 y 2013 con relación a diferentes variables. Material y métodos. Hemos analizado 127 cirugías de revisión de artroplastia total de cadera realizadas en 127 pacientes en nuestro centro durante dicho periodo. Se registraron parámetros como edad, sexo, fecha de artroplastia primaria, fecha de reemplazo de prótesis y causa principal de reintervención. Se consideraron rescate precoz aquellas reintervenciones realizadas antes de los 5 años tras la artroplastia primaria. Resultados. La causa de rescate más frecuente fue el aflojamiento 38 (30%) seguido de inestabilidad 30 (24%). En cuanto a la edad en el momento del rescate, se encontraron diferencias estadísticamente significativas: los pacientes con reintervención por fractura eran significativamente mayores. Se encontraron diferencias en cuanto a la edad en la primera cirugía: eran 7 años más jóvenes aquellos con rescates tardíos (63,40) con respecto a los precoces (70,21). Discusión. Hemos observado resultados similares a los de las demás series publicadas, excepto una mayor incidencia de inestabilidad en rescate precoz. Conclusiones. Este estudio demuestra el aflojamiento aséptico y la inestabilidad como causas más frecuentes de rescate en nuestro centro. La edad es un factor muy influyente en cuanto a la longevidad de la artroplastia primaria. Son mayores las complicaciones en pacientes en los cuales se implanta la artroplastia primaria de cadera a edad más avanzada (AU)

Objective. To determine the impact of each cause of revision surgery in total hip arthroplasty during the period 2009-2013. To analyse the relationship between these causes with different variables. Materials and methods. A study was conducted on 127 patients who had hip replacement revision surgery in our hospital during this period. Parameters, such as age, sex, date of primary arthroplasty, prosthetic replacement date, and main cause of the revision were recorded. Those revisions performed within 5 years after the primary arthroplasty were considered as early rescue. Results. The most common cause of rescue was aseptic loosening in 38 (30%) followed by instability in 30 (24%). In terms of age at the time of rescue, statistically significant differences were found, with it being significantly higher in patients re-operated for a fracture. Differences in age at first surgery were found to be 7 years younger than those with late rescue (63.40) with respect to early (70.21). Discussion. Similar results to ours have been observed in other published series, except for the higher incidence of instability in early rescue. Conclusions. This study demonstrates aseptic loosening and instability as the most frequent causes of revision surgery in our hospital. Age is a very influential factor in relation to longevity of primary arthroplasty. Complications were higher in when the primary hip replacement is implanted in older patients (AU)