Factors affecting lifespan following below-knee amputation in diabetic patients

Abstract

IntroductionUntreatable foot problems in diabetics may require lower extremity amputation, which has a high level of patient mortality. This high mortality rate is worse than most malignancies. The present study aimed to identify parameters that can be used to estimate survival in DM patients undergoing below-knee amputations for diabetic foot problems.Materials and methodsA total of 470 patients (299 males, 171 females) with a mean age of 64.32 years who underwent below-knee amputation for diabetic foot problems between 2004 and 2014 were enrolled in the study. The length of time from the operation to time of death was recorded in days. Patient details were obtained, including age during surgery, BMI, oral antidiabetic and insulin usage, dialysis therapy history, lower extremity endovascular intervention, previous amputation at the same extremity, the need for stump revision surgery during follow-up, and above-knee amputation at the same site. Biochemical test results of pre-operative HbA1c, ESR, and levels of CRP, BUN, and creatinine were also obtained.ResultsA total of 333 patients (70.9%) died and 137 (29.1%) survived post-surgery. Survival rates were 90% in the first 7 days, 84% in the first 30 days, and 64% after the first year. Patient median life expectancy post-surgery was 930 ± 106 days. Hemodialysis treatment (p = 0.001), endovascular intervention (p = 0.04), sex (p = 0.004), age (p = 0.001), BUN level (p = 0.001), and duration of insulin use (p = 0.003) were shown to be effective predictors of mortality.ConclusionsLife expectancy is low (<3 years) in DM patients requiring below-knee amputations for untreatable foot problems. Survival could be predicted by duration of insulin use, age, sex, and renal insufficiency.Level of evidenceLevel IV, Therapeutic study.

Time Trends in the Incidence of Long-Term Mortality in T2DM Patients Who Have Undergone a Lower Extremity Amputation. Results of a Descriptive and Retrospective Cohort Study

“…Those results agree with ours, showing that chronic renal disease, with or without dialysis, increases the risk of dying aside from the level of amputation. Beyaz et al reported that hemo-dialysis increases mortality by 1.53 times (95% CI, 1.218–1.936) among diabetic patients undergoing below-knee amputations [54].…”

Edetate Disodium-based Treatment in a Woman with Diabetes and Critical Limb Ischemia Scheduled for Lower Extremity Amputation

“…Although men undergo more non-traumatic, vascular-related amputations of the lower extremities, women are usually more severely ill and affected at a more advanced age [6]. It is underappreciated that women tend to have a significantly shorter (1.38 times) post-operative lifetime (95% CI, 1.11-1.72, p = 0.04) after below-the-knee amputation [2]. In 2013, we reported a benefit of edetate disodium-based therapy in patients with a prior myocardial infarction (MI) [7].…”

“…Critical limb ischemia (CLI) carries a mortality rate of 24% at one year and 54-60% at five years, a mortality more severe than most cancers [1]. It is underappreciated that women undergoing amputation for CLI are older, more severely ill, and have a poorer prognosis than men [2]. Epidemiological studies have shown an association between environmentally acquired vasculotoxic metals, coronary events, and peripheral artery disease [3-5].…”

Acceptance of Illness, Quality of Life and Nutritional Status of Patients After Lower Limb Amputation Due to Diabetes Mellitus

“…The risk of limb amputation in diabetic patients is 15 to 20 times higher than that in non-diabetic individuals, reaching even 15% [1,2]. Overall mortality after amputation ranges from 13-40% at 1 year, 35-65% at 3 years, and 39-80% at 5 years [3].…”