NONTRAUMATIC LOWER-EXTREMITY AMPUTATIONS IN DIABETIC AND NONDIABETIC SUBJECTS IN MADRID, SPAIN

The purpose of this study was to determine the incidence of non-trauma tic lower extremity amputations (LEAs) in diabetic and non-diabetic su bjects in Madrid, Spain, and their direct cost. Ali pa tie nts who und erwent LEAs between the 1st of January 1994 and the 31st of December 1 996, and who had lived in area 7 of the city(569,307 inhabitants) for at least the last 6 months, were identified through operating theatre records cross-checked with Vascular Surgery Department discharge recor ds. In addition, the direct cost of LEAs per year was estimated, takin g into account the length of the hospital stay, the period of rehabili tation in the outpatient clinic after discharge, and the use of artifi cial limbs and their maintenance. The incidence of LEAs was 1.6(95 % C I :1.1-2.2) per 10(5) non-diabetic subjects and 46.1 (95 % CI:34.5-57. 6) per 10(5) diabetic patients. Relative risk was 28. Total direct cos ts associated with LEAs per year were USS 56,131 in the diabetic popul ation and US$ 30,765 in the non-diabetic population. Thus, potential c ost savings associated with excess amputations in the diabetic populat ion was estimated at USS 541,353 per year or US$ 94,736 per 10(5) inha bitants. It is concluded that the incidence of LEAs in both diabetic a nd non-diabetic populations in area 7 is the lowest reported in Europe an countries. The potential cost savings per 10(5) inhabitants and per year is estimated at USS 94,736.