Dysvascular lower limb amputation: incidence, survival and pathways of care

The overwhelming majority of lower limb amputations in western countries is caused by peripheral arterial disease and/or diabetes mellitus. Historically, lower limb amputations occur rarely on a population level, but they are associated with strikingly high mortality rates. In the Netherlands a more elderly age distribution in the population and more prevalent peripheral arterial disease and diabetes mellitus are observed in the past decades. However, there have also been advancements in the treatments of peripheral arterial disease and diabetes mellitus. This leads to the question: where do we stand in the Netherlands with regard to (prevention of) lower limb amputation? In order to asses this, an observational study was performed: medical records of all persons undergoing lower limb amputation in the Northern provinces of the Netherlands in 2012 and 2013 were analyzed and compared to previous research for the periods 1991-1992 and 2002-2003. The thesis shows that there has been a decrease in the incidence rate of lower limb amputation in the Northern region of the Netherlands in the past two decades. The high mortality rates are not to be underestimated: one in three persons does not survive the first year after the amputation. Presumably, this is related to the considerable comorbidity among persons undergoing lower limb amputation. Those who do survive the amputation, are often unable to return to home after discharge from the hospital. However, more than 75% do return home within one year of the amputation, through either inpatient rehabilitation or geriatric rehabilitation in skilled nursing facilities.