Perioperative and long-term all-cause mortality in patients with diabetes who underwent a lower extremity amputation

Abstract

Introduction: Long-term mortality of patients with diabetes who undergo lower extremity amputation (LEA) has not been reported in Spain.

Methods: The retrospective cohort included all subjects who underwent LEAs from January 1, 2005 to December 31, 2015 in San Jorge Hospital, Huesca, Spain. Live status of every patient up to September 2017 and the date of death were retrieved using the national death index.

Results: The series included 203 patients: 116 patients (57.1%) underwent a minor amputation and 87 patients (42.9%) underwent a major amputation. Twenty-five patients (12.3%) died in the perioperative period. Significant risk factors of perioperative mortality were undergoing an above-the-knee amputation, postoperative cardiac complications, age >74 years and acute renal failure. Survival rates at 1, 3, and 5 years were 90.6, 72.8, and 55.5% in patients who underwent a minor amputation compared with 70.8, 41.3, and 34.4% in patients who underwent a major amputation, respectively. Log-rank test between the two groups was χ² = 12.7 (p < 0.01).

Conclusions: Long-term survival was worse in patients who underwent a major amputation with a 5-year mortality of 65.6%. This mortality is worse than what has been reported for some types of common malignancies.

Keywords: Critical ischaemia; Diabetic foot; Diabetic foot ulcers; Lower extremity amputation; Lower limb ischaemia; Mortality.