Mortality After Nontraumatic Major Amputation Among Patients With Diabetes and Peripheral Vascular Disease: A Systematic Review

J Foot Ankle Surg. 2016 May-Jun;55(3):591-9. doi: 10.1053/j.jfas.2016.01.012. Epub 2016 Feb 19.


High mortality rates have been reported after major amputations of a lower limb secondary to diabetes and peripheral vascular disease. However, the mortality rates have varied across studies. A systematic review of the 5-year mortality after nontraumatic major amputations of the lower extremity was conducted. A data search was performed of Medline using OVID, CINHAL, and Cochrane, 365 abstracts were screened, and 79 full text articles were assessed for eligibility. After review, 31 studies met the inclusion and exclusion criteria. Overall, the 5-year mortality rate was very high among patients with any amputation (major and minor combined), ranging from 53% to 100%, and in patients with major amputations, ranging from 52% to 80%. Mortality after below-the-knee amputation ranged from 40% to 82% and after above-the-knee amputation from 40% to 90%. The risk factors for increased mortality included age, renal disease, proximal amputation, and peripheral vascular disease. Although our previous systematic review of the 5-year mortality after ulceration had much lower rates of death, additional studies are warranted to determine whether amputation hastens death or is a marker for underlying disease severity.

Keywords: above-the-knee amputation; below-the-knee amputation; death; renal disease; survival.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Amputation, Surgical / methods
  • Amputation, Surgical / mortality*
  • Cause of Death*
  • Diabetic Angiopathies / diagnosis
  • Diabetic Angiopathies / mortality*
  • Diabetic Angiopathies / surgery*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Peripheral Vascular Diseases / diagnosis
  • Peripheral Vascular Diseases / mortality*
  • Peripheral Vascular Diseases / surgery*
  • Prognosis
  • Risk Assessment
  • Sex Factors
  • Survival Analysis