Mortality in Diabetic and Nondiabetic Patients After Amputations Performed From 1990 to 1995

Abstract

OBJECTIVE -To compare survival rates after first amputation between patients with and without diabetes.RESEARCH DESIGN AAND METHODS -We performed a retrospective study of all nontraumatic amputations performed at our center in the years 1990 -1995 in patients with (n ϭ 100) and without (n ϭ 151) diabetes. Survival status was assessed from the first amputation until 31 December 2001.RESULTS -Altogether, 61% of the patients with and 54.3% of those without diabetes died 5.2 (4.5-5.8) and 5.3 (4.7-5.9) [mean (95% CI)] years after the first amputation, respectively (P ϭ 0.80). Survival was not different between patients with and without diabetes after controlling for the level (major versus minor) (P ϭ 0.67) or the cause (ischemia versus infection) of amputation (P ϭ 0.72). No sex differences were found for survival in either study group. Independent predictors of mortality in the diabetic group were duration of diabetes (P ϭ 0.05), history of stroke (P ϭ 0.02), and serum creatinine level (P Ͻ 0.0001), while in the nondiabetic group independent predictors were history of stroke (P ϭ 0.04), serum creatinine level (P ϭ 0.005), and higher white blood cell count (P ϭ 0.02). The peak incidence of amputations was observed in the decade of 67-76 years of age in both groups. Major amputations were more common among nondiabetic patients in all age-groups. Median hospital stay and postoperative complications were comparable between the two groups.CONCLUSIONS -All-cause mortality is high after an amputation in both diabetic and nondiabetic patients. Mortality rates, hospital stay, and postoperative complications are not different between diabetic and nondiabetic amputees. No modifiable factors, with the exception of nephropathy, were found to improve survival in amputees. Peripheral vascular disease and neuropathy are the main cause of amputations; prevention, therefore, of these complications is warranted to prevent amputations and the subsequent high mortality. Diabetes Care 27:1598 -1604, 2004D iabetes is the cause of almost 50% of all nontraumatic lower-extremity amputations worldwide (1-5). It is estimated that the lifetime risk for amputation in patients with diabetes is 10 -15%, 10 -30 times higher in comparison with the general population (2,3). Amputation is associated with a high rate of subsequent amputation and considerable health care cost in both patients with and without diabetes (6,7). Most amputations in diabetic patients are due to peripheral vascular disease, peripheral neuropathy, and infection, while in nondiabetic patients peripheral vascular disease is the main cause (2,8). Previous studies have demonstrated an increased mortality following an amputation in both diabetic and nondiabetic patients (4,9 -12). However, no recent data exist concerning the comparison in survival after an amputation between diabetic and nondiabetic patients. The primary objective of this study was to look at the outcome of amputees and compare it between those with and without diabetes to see if there are any modifiable risk fac...

The Diabetic Foot in End Stage Renal Disease

“…[11] Moreover, mortality in amputees is extremely high. [16] Three major pathologies-neuropathy, ischemia, and infection-interact by miscellaneous routes, resulting in the diabetic foot (see Table 1). [10,12,13] Neuropathy is often considered as the cardinal driving force to ulceration, [10,12,17] as it has been implicated in the pathogenesis of foot ulceration in the majority of cases.…”

Association Between Renal Failure and Foot Ulcer or Lower-Extremity Amputation in Patients With Diabetes

“…In 1995, U.S. Medicare claims for DFUs exceeded $1.4 billion (2). LEAs also have a profound effect on quality of life and are associated with increased health care costs and an increased risk of mortality (3)(4)(5). Nontraumatic LEAs are at least 15 times more prevalent in those with diabetes than in those with any other concomitant medical illness (3,6).…”

Predictors of Lower-Extremity Amputation in Patients With an Infected Diabetic Foot Ulcer

“…Among patients with a DFI, ;5% will undergo a major amputation and 20-30% a 1 minor amputation, with the presence of peripheral arterial disease (PAD) greatly increasing amputation risk (4)(5)(6). Furthermore, lower-limb amputation is associated not only with significant morbidity and mortality but also with major psychosocial and financial consequences (7)(8)(9).…”