Epidemiology of major amputation following diabetic foot ulcer: Insights from recent nationwide data in the french national health registry (SNDS) - 22/01/25
Highlights |
• | Care pathways of people with diabetic foot ulcer (DFU) and its impact on wound prognosis are poorly studied. |
• | We found known negative prognostic factors as well as others less well explored, such as psychiatric diseases. |
• | Inclusion in care pathways and living in less disadvantaged areas are associated with fewer major amputations. |
• | A large number of amputations are not preceded by a hospitalization for DFU. |
• | These results emphasize the need for multidisciplinary work through coordinated care pathways to avoid major amputations in people with DFU. |
Abstract |
Objective |
The out-of-hospital care pathways of people with DFU have been little studied. We used the French National Health Data System (SNDS) to collect refund and care pathway data for all French residents. The aim of this study was to determine the incidence of major lower limb amputation (MA) and associated risk factors in a population with an incident DFU.
Research Design and Methods |
We included any person living with diabetes and incident DFU. The primary endpoint was the occurrence of MA within one year. We considered the course and consumption of care one year before and one year after the initial event.
Results |
In 2018, 133,791 people were included, and during the follow-up, MA was performed in 4,733 (3.5 %). Among these people with MAs, 16.4 % were included via the out-of-hospital part of the protocol, and their first contact with the hospital led to MA. Factors associated (hazard ratio, HR [95 % confidence interval, CI]) with MA were: being male (1.92 [1.78;2.08]), arteriopathy of the lower limb (10.16 [9.36;11.03]), psychiatric disease (1.10 [1.01;1.20]) and end-stage renal disease (2.12 [1.93;2.33]).
Regarding the care pathway, associations (HR [95 %CI]) were observed between lower MA rates and people with more general practitioner (0.83 [0.75–0.91]), private nurse (0.88 [0.81–0.95]) and diabetologist (0.88 [0.81–0.95]) visits.
Living in the most disadvantaged municipalities was associated (HR [95 %CI]) with a higher MA rate (1.17[1.06–1.29]).
Conclusion |
This is the first national study of the care pathways followed by people with DFU. Failures in the care pathway, precariousness and several comorbidities were identified, with an impact on the MA risk.
Le texte complet de cet article est disponible en PDF.Keywords : Amputation, Diabetic foot ulcer, Epidemiology, French national health data system
Plan
Vol 51 - N° 2
Article 101606- mars 2025 Retour au numéro
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