Trends in lower limb amputation in the Veterans Health Administration, 1989-1998

Objective: To assess trends in lower limb amputation performed in Veterans Health Administration (VHA) facilities. Methods: All lower limb amputations recorded in the Patient Treatment File for 1989-1998 were analyzed using the hospital discharge as the unit of ana lysis. Age-specific rates were calculated using the VHA user-population as the denominator. Frequency tables and linear, logistic, and Poisson regress ion were used respectively to assess trends in amputation numbers, reoperat ion rates, and age-specific amputation rates. Results: Between 1989-1998, t here were 60,324 discharges with amputation in VHA facilities. Over 99.9% o f these were in men and constitute 10 percent of all US male amputations. T he major indications were diabetes (62.9%) and peripheral vascular disease alone (23.6%). The age-specific rates of major amputation in the VHA are hi gher than US rates of major amputation. VHA rates of major and minor amputa tion declined an average of 5% each year, while the number of diabetes-asso ciated amputations remained the same. Conclusion: The number and age-specif ic rates of amputations decreased over 10 years despite an increase in the number of veterans using VHA care.