The long-term mobility and mortality of patients with peripheral arterial disease following bilateral amputation

Inderbitzi, Rolf; Buettiker, M.; Enzler, M

doi:10.1053/ejvs.2002.1868

Cited by 33 publications

(30 citation statements)

References 15 publications

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“…Thus, it is not surprising that the results of this study suggest even poorer functional outcomes among a largely dysvascular Veteran population than had been previously reported. Specifically, only 11 percent of Veterans in our cohort remained ambulatory after undergoing bilateral major amputations-much lower than the 38 percent rate reported by Inderbitzi et al [6]. With a similarly comorbid study population of 66 patients, Inderbitzi et al reported the mortality rate at 69 percent after 5 yr and coronary heart disease the leading cause of death [6].…”

Section: Discussioncontrasting

confidence: 60%

“…The few studies published on function after bilateral major amputations have not focused on the elderly population with peripheral arterial disease (PAD) and/or diabetes typically encountered by the vascular surgeon. Nonetheless, these studies suggest that 60 percent lose ambulatory ability and 65 percent lose their ability to live independently [6][7].…”

Section: Introductionmentioning

confidence: 98%

“…Previous reports suggest a comparable disadvantage following major amputation: whereas about 55 percent of those undergoing nontraumatic major lower-limb amputation remain ambulatory [5] only about 38 percent of those with a prior history of contralateral limb loss remain ambulatory following loss of the second lower limb [6]. The few studies published on function after bilateral major amputations have not focused on the elderly population with peripheral arterial disease (PAD) and/or diabetes typically encountered by the vascular surgeon.…”

Section: Introductionmentioning

confidence: 99%

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Ambulation and independence among Veterans with nontraumatic bilateral lower-limb loss

Sharath

Henson

Flynn³

et al. 2015

J Rehabil Res Dev

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Abstract-In describing functional outcomes and independent living in a cohort of bilateral major amputees, we sought to provide current estimates of function and independence after a second major amputation in an elderly Veteran population with peripheral arterial disease and/or diabetes. After retrospectively reviewing and excluding the electronic health records of those failing to meet the inclusion criteria, we identified 40 patients with a history of unilateral major amputation who underwent a second major amputation during the defined study period. Of these, 43% (17) were bilateral transfemoral amputations (TFAs); bilateral transtibial amputations (TTAs) and TFA-TTA accounted for the rest (33% and 25%, respectively). Of the 19 (48%) patients who were ambulatory prior to bilateral amputation, only 2 (11%) remained ambulatory after the second amputation, while 17 (89%) patients lost ambulatory capabilities. Compared with those who were

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Section: Discussioncontrasting

confidence: 60%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Ambulation and independence among Veterans with nontraumatic bilateral lower-limb loss

Sharath

Henson

Flynn³

et al. 2015

J Rehabil Res Dev

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“…Increasing age has also been associated with worse long-term outcome in previous studies [4,6,12]. These findings are unsurprising, and it is likely that longer-term outcome is related to the severity of co-existing diseases [15]. For example, Tseng et al found in a cohort of diabetic patients that continued smoking was associated with long-term mortality, but that the commonest recorded cause of death was diabetes itself [16].…”

Section: Discussionmentioning

confidence: 94%

Factors influencing short‐ and long‐term mortality after lower limb amputation

et al. 2014

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SummaryMortality after lower limb amputation is high, with UK 30-day mortality rates of 9-17%. We performed a retrospective analysis of factors affecting early and late outcome after lower limb amputation for peripheral vascular disease or diabetic complications at a UK tertiary referral vascular centre between 2003 and 2010. Three hundred and thirty-nine patients (233 male), of median (IQR [range]) age 73 (62-79 [26-92]) years underwent amputation. Thirty-day mortality was 12.4%. On regression modelling, the risk of 30-day mortality was increased in patients of ASA grade ≥ 4 (OR 4.23, 95% CI 2.07-8.63), p < 0.001 and age between 74 and 79 years (OR 3.8, 95% CI 1.10-13.13), p = 0.04 and older than 79 years (OR 4.08, 95% CI 1.25-13.25), p = 0.02. Peri-operative (30-day) mortality for these groups was 23.2%, 13.7% and 18.8%, respectively. Survival and Cox regression analysis demonstrated that long-term mortality was associated with: age 74-79 years (HR 2.15, 95% CI 1.38-3.35), p = 0.001; age > 79 years (HR 2.78, 95% CI 1.82-4.25), p < 0.001; ASA grade ≥ 4 (HR 2.04, 95% CI 1.51-2.75), p < 0.001; out-of-hours operating (HR 1.51, 95% CI 1.08-2.10), p = 0.02; and chronic kidney disease stage 4-5 (1.57, 95% CI 1.07-2.30), p = 0.02. Anaesthetic technique was associated with long-term mortality on survival analysis (p = 0.04), but not when analysed using regression modelling. Mortality after lower limb amputation relates to patient age, ASA, out-of-hours surgery and renal dysfunction. These data support lower limb amputations' being performed during daytime hours and after modification of correctable risk factors.

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“…[32][33][34] Responders were more likely to have an intact trial leg and, presumably therefore, to exhibit higher levels of generic but especially disease-specific HRQOL. [35][36][37][38][39][40][41] Like PREVENT III, nonresponse was associated with amputation, and this limited the information available to measure the effects of the alternative management strategies on HRQOL in this patient subgroup.…”

Section: Discussionmentioning

confidence: 99%

Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: Health-related quality of life outcomes, resource utilization, and cost-effectiveness analysis

Forbes

Adam

Bell

et al. 2010

Journal of Vascular Surgery

118

101

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Adopting a BSX-first strategy for patients with severe limb ischemia does result in a modest increase in hospital costs, with a small positive but insignificant gain in disease-specific and generic HRQOL. However, the real-world choice between BSX-first and BAP-first revascularization strategies for severe limb ischemia due to infrainguinal disease cannot depend on costs alone and will require a more comprehensive consideration of individual patient preferences conditioned by expectations of survival and other health outcomes.

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The long-term mobility and mortality of patients with peripheral arterial disease following bilateral amputation

Cited by 33 publications

References 15 publications

Ambulation and independence among Veterans with nontraumatic bilateral lower-limb loss

Ambulation and independence among Veterans with nontraumatic bilateral lower-limb loss

Factors influencing short‐ and long‐term mortality after lower limb amputation

Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: Health-related quality of life outcomes, resource utilization, and cost-effectiveness analysis

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