Survival and factors predicting mortality after major and minor lower-extremity amputations among patients with diabetes: a population-based study using health information systems

Abstract

IntroductionThe aim of the study was to identify the sociodemographic and clinical factors associated with death after the first lower-extremity amputation (LEA), minor and major separately, using data from regional health administrative databases.Research design and methodsWe carried out a population-based cohort study including patients with diabetes residing in the Lazio region and undergoing a primary amputation in the period 2012–2015. Each individual was followed up for at least 2 years. Kaplan-Meier analysis was used to evaluate long-term survival; Cox proportional regression models were applied to identify factors associated with all-cause mortality.ResultsThe cohort included 1053 patients, 72% were male, 63% aged ≥65 years, and 519 (49%) died by the end of follow-up. Mortality rates at 1 and 4 years were, respectively, 33% and 65% for major LEA and 18% and 45% for minor LEA. Significant risk factors for mortality were age ≥65, diabetes-related cardiovascular complications, and chronic renal disease for patients with minor LEA, and age ≥75 years, chronic renal disease and antidepressant drug consumption for subjects with major LEA.ConclusionsThe present study confirms the high mortality rates described in patients with diabetes after non-traumatic LEA. It shows differences between minor and major LEA in terms of mortality rates and related risk factors. The study highlights the role of depression as specific risk factor for death in patients with diabetes after major LEA and suggests including its definition and management in strategies to reduce the high mortality rate observed in this group of patients.

Amputations of Lower Limb in Subjects with Diabetes Mellitus: Reasons and 30-Day Mortality

“…In a national study performed in New Zealand on individuals diagnosed with diabetes, more than 11% of patients who underwent major amputation died within 30 days, whereas nearly 18% died within 90 days [ 9 ]. In another population-based cohort study conducted in Italy, including patients with diabetes undergoing a primary amputation, mortality rates at 1 and 4 years were 33% and 65%, respectively, for major LEA and 18% and 45% for minor LEA [ 10 ].…”

Impact of the COVID‐19 pandemic on access to healthcare services amongst patients with multiple sclerosis in the Lazio region, Italy

“…With the recent lockdown and unavoidable changes to healthcare delivery, patients with MS may have had limited access to usual medical services (infusions, physical therapy, occupational therapy and homecare services), because of either unavailability or the fear of SARS-CoV-2 infection. In the Lazio region, health administrative databases are comprehensive and contain highquality information, allowing for region-wide public health monitoring and research [14,15]. A validated algorithm is used to identify MS cases within healthcare administrative databases, for healthcare planning and monitoring purposes [16].…”

Racial, Rural, and Regional Disparities in Diabetes-Related Lower-Extremity Amputation Rates, 2009–2017

“…However, from a clinical standpoint, major LEAs can be more functionally devastating than minor ones and have been shown to be associated with increased morbidity and mortality due to increased body mass loss, lack of ambulation, and cardiovascular complications (29). Moreover, higher levels of depression (30) and reduced health-related quality of life have been reported with major amputations, particularly among nonambulatory patients (31). Hence, in some cases, a minor amputation may be considered a success for a patient.…”