Diabetic Foot: Mortality Rates After Major Amputation
Article Sidebar
Published:
Feb 17, 2023
Keywords:
diabetic foot, amputation, mortality
Main Article Content
Abstract
Introduction: Major amputations cause a high rate of morbidity and mortality. Our objectives were to evaluate the mortality rate in the first month, and 2 and 5 years after amputation for diabetic foot and to compare the mortality rate in patients with below-theknee (BKA) and above-the-knee amputations (AKA).
Materials and Methods: Sixty patients with 64 major amputations, operated on between 2010 and 2018, were retrospectively evaluated. The following information was collected: personal data, laterality, University of Texas classification score, biochemical analysis results, Doppler studies, comorbidities, survival, and cause of death. The overall mortality rate and the mortality rate by type of amputation in the first month and after 2 and 5 years were calculated.
Results: 58 amputations were performed in men and 6 in women (37 right, 27 left), 39 were AKA and 25 were BKA. The average age was 68 years. There were 28 deaths: 15 patients with AKA and 13 with BKA. Mortality rates were: 13.33% in the first month, 33.3% after 2 years, and 46.42% after 5 years (patients with AKA, 26.78%; patients with BKA, 19.64%). The differences in the creatinine levels of the patients who died were statistically significant. The main causes of death were cardiovascular complications.
Conclusions: Mortality rates were significantly higher in patients with above-the-knee amputation. The sepsis-related mortality rate in the first month was high. Patients with kidney disease had a higher mortality rate.
Materials and Methods: Sixty patients with 64 major amputations, operated on between 2010 and 2018, were retrospectively evaluated. The following information was collected: personal data, laterality, University of Texas classification score, biochemical analysis results, Doppler studies, comorbidities, survival, and cause of death. The overall mortality rate and the mortality rate by type of amputation in the first month and after 2 and 5 years were calculated.
Results: 58 amputations were performed in men and 6 in women (37 right, 27 left), 39 were AKA and 25 were BKA. The average age was 68 years. There were 28 deaths: 15 patients with AKA and 13 with BKA. Mortality rates were: 13.33% in the first month, 33.3% after 2 years, and 46.42% after 5 years (patients with AKA, 26.78%; patients with BKA, 19.64%). The differences in the creatinine levels of the patients who died were statistically significant. The main causes of death were cardiovascular complications.
Conclusions: Mortality rates were significantly higher in patients with above-the-knee amputation. The sepsis-related mortality rate in the first month was high. Patients with kidney disease had a higher mortality rate.
Downloads
Download data is not yet available.
Metrics
Metrics Loading ...
Article Details
How to Cite
Coria, H. E., Sartorelli, D., Taffarel, B., Pérez Di Felice, M. E., Anfuso, H. S., Silvestri, A. E., & Fedun Rodríguez, E. (2023). Diabetic Foot: Mortality Rates After Major Amputation. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(1), 53-58. https://doi.org/10.15417/issn.1852-7434.2023.88.1.1592
Section
Clinical Research
Copyright (c) 2023 Revista de la Asociación Argentina de Ortopedia y Traumatología
Manuscript acceptance by the Journal implies the simultaneous non-submission to any other journal or publishing house. The RAAOT is under the Licencia Creative Commnos Atribución-NoComercial-Compartir Obras Derivadas Igual 4.0 Internacional (CC-BY-NC.SA 4.0) (http://creativecommons.org/licences/by-nc-sa/4.0/deed.es). Articles can be shared, copied, distributed, modified, altered, transformed into a derivative work, executed and publicly communicated, provided a) the authors and the original publication (Journal, Publisher and URL) are mentioned, b) they are not used for commercial purposes, c) the same terms of the license are maintained.
In the event that the manuscript is approved for its next publication, the authors retain the copyright and will assign to the journal the rights of publication, edition, reproduction, distribution, exhibition and communication at a national and international level in the different databases. data, repositories and portals.
It is hereby stated that the mentioned manuscript has not been published and that it is not being printed in any other national or foreign journal.
The authors hereby accept the necessary modifications, suggested by the reviewers, in order to adapt the manuscript to the style and publication rules of this Journal.
References
1. Armstrong DG, Wrobel J, Robbins JM. Guest Editorial: are diabetes-related wounds and amputations worse than cancer? Int Wound J 2007;4(4):286-7. https://doi.org/10.1111/j.1742-481X.2007.00392.x
2. Hoffmann M, Kujath P, Flemming A, Proß M, Begum N, Zimmermann M, et al. Survival of diabetes patients with major amputation is comparable to malignant disease. Diab Vasc Dis Res 2015;12(4):265-71.
https://doi.org/10.1177/1479164115579005
3. Jupiter DC, Thorud JC, Buckley CJ, Shibuya N. The impact of foot ulceration and amputation on mortality in
diabetic patients. I: From ulceration to death, a systematic review. Int Wound J 2016;13(5):892-903.
https://doi.org/10.1111/iwj.12404
4. Terry Canale S (ed). Campbell. Cirugía ortopédica. 10th ed. Madrid: Elsevier; 2004, vol. 1, pág. 575-85.
5. Guía de Práctica Clínica de Educación en Diabetes. Disponible en: https://www.idf.org/e-library/guidelines/-global-guideline-for-type--
6. Thorud JC, Plemmons B, Buckley CJ, Shibuya N, Jupiter DC. Mortality after nontraumatic major amputation
among patients with diabetes and peripheral vascular disease: A systematic review. J Foot Ankle Surg
2016;55(3):591-9. https://doi.org/10.1053/j.jfas.2016.01.012
7. Schofield CJ, Libby G, Brennan GM, MacAlpine RR, Morris AD, Leese GP. Mortality and hospitalization
in patients after amputation: A comparison between patients with and without diabetes. Diabetes Care
2006;29(10):2252-6. https://doi.org/10.2337/dc06-0926
8. Soo BP, Rajbhandari S, Egun A, Ranasinghe U, Lahart IM, Pappachan JM. Survival at 10 years following lower
extremity amputations in patients with diabetic foot disease. Endocrine 2020;69(1):100-6. https://doi.org/10.1007/s12020-020-02292-7
9. Subramaniam B, Pomposelli F, Talmor D, Park KW. Perioperative and long-term morbidity and mortality after
above-knee and below-knee amputations in diabetics and nondiabetics. Anesth Analg 2005;100(5):1241-7.
https://doi.org/10.1213/01.ANE.0000147705.94738.31
10. Brownrigg JRW, Davey J, Holt PJ, Davis WA, Thompson MM, Ray KK, et al. The association of ulceration of
the foot with cardiovascular and all-cause mortality in patients with diabetes: a meta-analysis. Diabetologia
2012;55(11):2906-12. https://doi.org/10.1007/s00125-012-2673-3
11. Park YH, Song JH, Choi GW, Kim HJ. Predictors of complication following lower extremity amputation in diabetic end-stage renal disease. Nephrology 2018;23(6):518-22. https://doi.org/10.1111/nep.13066
12. Stern JR, Wong CK, Yerovinkina M, Spindler SJ, See AS, Panjaki S, et al. A meta-analysis of long-term mortality
and associated risk factors following lower extremity amputation. Ann Vasc Surg 2017;42:322-7.
https://doi.org/10.1016/j.avsg.2016.12.015
13. Davenport DL, Ritchie JD, Xenos ES. Incidence and risk factors for 30-day postdischarge mortality in patients with vascular disease undergoing major lower extremity amputation. Ann Vasc Surg 2012;26(2):219-24.
https://doi.org/10.1016/j.avsg.2011.05.012
2. Hoffmann M, Kujath P, Flemming A, Proß M, Begum N, Zimmermann M, et al. Survival of diabetes patients with major amputation is comparable to malignant disease. Diab Vasc Dis Res 2015;12(4):265-71.
https://doi.org/10.1177/1479164115579005
3. Jupiter DC, Thorud JC, Buckley CJ, Shibuya N. The impact of foot ulceration and amputation on mortality in
diabetic patients. I: From ulceration to death, a systematic review. Int Wound J 2016;13(5):892-903.
https://doi.org/10.1111/iwj.12404
4. Terry Canale S (ed). Campbell. Cirugía ortopédica. 10th ed. Madrid: Elsevier; 2004, vol. 1, pág. 575-85.
5. Guía de Práctica Clínica de Educación en Diabetes. Disponible en: https://www.idf.org/e-library/guidelines/-global-guideline-for-type--
6. Thorud JC, Plemmons B, Buckley CJ, Shibuya N, Jupiter DC. Mortality after nontraumatic major amputation
among patients with diabetes and peripheral vascular disease: A systematic review. J Foot Ankle Surg
2016;55(3):591-9. https://doi.org/10.1053/j.jfas.2016.01.012
7. Schofield CJ, Libby G, Brennan GM, MacAlpine RR, Morris AD, Leese GP. Mortality and hospitalization
in patients after amputation: A comparison between patients with and without diabetes. Diabetes Care
2006;29(10):2252-6. https://doi.org/10.2337/dc06-0926
8. Soo BP, Rajbhandari S, Egun A, Ranasinghe U, Lahart IM, Pappachan JM. Survival at 10 years following lower
extremity amputations in patients with diabetic foot disease. Endocrine 2020;69(1):100-6. https://doi.org/10.1007/s12020-020-02292-7
9. Subramaniam B, Pomposelli F, Talmor D, Park KW. Perioperative and long-term morbidity and mortality after
above-knee and below-knee amputations in diabetics and nondiabetics. Anesth Analg 2005;100(5):1241-7.
https://doi.org/10.1213/01.ANE.0000147705.94738.31
10. Brownrigg JRW, Davey J, Holt PJ, Davis WA, Thompson MM, Ray KK, et al. The association of ulceration of
the foot with cardiovascular and all-cause mortality in patients with diabetes: a meta-analysis. Diabetologia
2012;55(11):2906-12. https://doi.org/10.1007/s00125-012-2673-3
11. Park YH, Song JH, Choi GW, Kim HJ. Predictors of complication following lower extremity amputation in diabetic end-stage renal disease. Nephrology 2018;23(6):518-22. https://doi.org/10.1111/nep.13066
12. Stern JR, Wong CK, Yerovinkina M, Spindler SJ, See AS, Panjaki S, et al. A meta-analysis of long-term mortality
and associated risk factors following lower extremity amputation. Ann Vasc Surg 2017;42:322-7.
https://doi.org/10.1016/j.avsg.2016.12.015
13. Davenport DL, Ritchie JD, Xenos ES. Incidence and risk factors for 30-day postdischarge mortality in patients with vascular disease undergoing major lower extremity amputation. Ann Vasc Surg 2012;26(2):219-24.
https://doi.org/10.1016/j.avsg.2011.05.012