Abstract
Purpose
The purpose of this study was to evaluate the survival after major lower-limb amputation, at a level either below (BKA) or above (AKA) the knee, in diabetic patients.
Methods
A total of 140 diabetic patients who underwent major lower-limb amputation during the period of 2001–2011 were enrolled in the study. The patients were grouped as below-knee and above-knee amputations. The differences in survival by age, gender, amputation level and revision surgery were investigated. The clinical follow-up periods and the results of the patients with major lower-limb amputation were retrospectively assessed.
Results
The mean follow-up period was 24.87 months (range 0.06–120 months). The mortality rate of series was 32.8 % for 1 year and 70 % for 5 years. One-year mortality rate was 24.6 % and 5-year mortality rate was 66.3 % in below-knee group, 1-year mortality rate was 43.3 % and 5-year mortality rate was 83.3 % in above-knee group. The difference between mortality rates of these groups was significant (p: 0.019). There was no statistically significant difference according to age and gender (p: 0.543 and 0.568). The previous minor amputations were found to have no effect on mortality (p: 0.471).
Conclusion
Routine utilization of diabetes follow-up, screening and treatment programs with a multidisciplinary approach might be mandatory to handle early multisystem involvement—prevent major amputation, and increase survival rate in diabetic patients.
Level of evidence
Retrospective cohort study, Level III.
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References
Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J (2005) The global burden of diabetic foot disease. Lancet 366:1719–1724
Pacilli A, Lamacchia O, Fontana A, Copetti M, Cignarelli M, Trischitta V, De Cosmo S (2015) Target values of cardiovascular risk factors are not associated with all-cause mortality in patients with type 2 diabetes mellitus. PLoS One 10(4):e0124536. doi:10.1371/journal.pone.0124536
Schaper NC, Andros G, Apelqvist J, International Working Group on Diabetic foot (2012) Specific guidelines for the diagnosis and treatment of peripheral arterial syndrome in a patient with diabetes and ulceration of the foot. Diabetes Metab Res 28(Suppl. 1):236–237
Alexioadou K, Doupis J (2012) Management of diabetic foot ulcers. Diabetes Ther 3:4
Schofield CJ, Libby G, Brennan GM, MacAlpine RR, Morris AD, Leese GP, DARTS, MEMO Collaboration (2006) Mortality and hospitalization in patients after amputation: a comparison between patients with and without diabetes. Diabetes Care 29:2252–2256
Fortington LV, Geertzen JHB, Van Netten JJ, Postema K, Rommers GM, Dijkstra PU (2013) Short and long term mortality rates after a lower limb amputation. Eur J Vasc Endovasc Surg 46–1:124–131
Hambleton IR, Fraser HS, Jonnalagadda R, Chaturvedi N, Davis CR, Hennis AJ (2009) All-cause mortality after diabetes-related amputation in Barbados. Diabetes Care 32:306–307
Icks A, Haastert B, Scheer M, Giani G, Morbach S, Glaeske G, Genz J, Hoffmann F (2011) Time-dependent impact of diabetes on mortality in patients after major lower extremity amputation. Diabetes Care 34:1350–1354
Akçay S, Satoğlu İS, Harman E, Kurtulmuş A, Kazımoğlu C (2012) A retrospective analysis of amputation rates and comorbidity in patients with diabetic foot ulcer. Med Sci 1(4):331–340
Kaya A, Aydin F, Altay T, Karapinar L, Ozturk H, Karakuzu C (2009) Can major amputation rates be decreased in diabetic foot ulcers with hyperbaric oxygen therapy? Int Orthop (SICOT) 33:441–446
Tentolouris N, Boulton AJM, Al-Sabbagh S, Jude EB, Walker MG (2004) Mortality in diabetic and nondiabetic patients after amputations performed from 1990 to 1995. Diabetes Care 27:1598–1604
Trautner C, Giani G, Hastert B, Berger M, Spraul M (2001) Unchanged incidence of lower-limb amputations in a German City, 1990–1998. Diabetes Care 24:855–859
Vamos EP, Valabhji J, Bottle A, Majeed A, Edmonds ME, Millett C (2010) Changes in the incidence of lower extremity amputations in individuals with and without diabetes in England between 2004 and 2008. Diabetes Care 33:2592–2597
Moulik PK, Mtonga R, Gill GV (2003) Amputation and mortality in new-onset diabetic foot ulcers stratified by etiology. Diabetes Care 26:491–494
Van Houtum WH, Schaper NC, Rauwerda JA, Bakker K, Ruwaard D (2004) Reduction in diabetes-related lower-extremity amputations in the Netherlands: 1991–2000. Diabetes Care 27:1042–1046
Resnick HE, Ness FK, Carter EA, Welty TK, LındsayR Lee ET, Henly SJ, Howard BV (2004) Relation of lower-extremity amputation to all-cause and cardiovascular disease mortality in American Indians. Diabetes Care 27:1286–1293
Lavery LA, Lavery DC, Hunt NA, William Van Houtum, Ndıp A, Boulton AJM (2010) Impact of chronic kidney disease on survival after amputation in individuals with diabetes. Diabetes Care 33:2365–2369
Morbach S, Roden T, Furchert H, Icks A, Groblinghoff U, Haastert B, Hoffmeıer H, Rumenapf G, Kersten K, Abbas ZG, Klauke G-T, Bharara M, Klemp U, Armstrong DG (2012) Long-term prognosis of diabetic foot patients and their limbs. Diabetes Care 35:2021–2027
Faglia E, Favales F, Morabito A (2001) New ulceration, new major amputation, and survival rates in diabetic subjects hospitalized for foot ulceration from 1990 to 1993. Diabetes Care 24:78–83
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Gök, Ü., Selek, Ö., Selek, A. et al. Survival evaluation of the patients with diabetic major lower-extremity amputations. Musculoskelet Surg 100, 145–148 (2016). https://doi.org/10.1007/s12306-016-0399-y
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DOI: https://doi.org/10.1007/s12306-016-0399-y