Skip to main content

Advertisement

SpringerLink
Log in

Survival at 10 years following lower extremity amputations in patients with diabetic foot disease

  • Original Article
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

Background

Amputations are associated with markedly reduced long-term survival in patients with diabetic foot disease. However, there is paucity of long-term survival data in published literature.

Methods

We searched the electronic case records and laboratory details of patients who underwent amputations between 1997 and 2006 to obtain at least 10 years of follow up data after the surgery to assess the survival rates and possible risk factors reducing survival in the year 2016. Amputation level below ankle was considered as minor and above ankle as major amputations.

Results

Of the 233 cases (159 males; median age 68 years), 161 had major amputations. Of the 72 cases who had minor amputations initially, 63 needed a further amputation or contralateral amputation on follow up. One hundred seventy-seven patients (76%) were not alive after 10 years of follow up. The survival rates at 1, 3, 5, 7, and ≥10 years were 64%, 50%, 40%, 34%, and 24%, respectively. Maximum number of deaths occurred within 4 months of amputations. There was no difference between survival rates following major or minor amputations and among males or females. The only statistically significant parameter affecting lower survival rate was age ≥70 years, with each additional year of age increasing the hazard by a factor of 1.039 (95% CI: 1.024–1.054) or 3.9% (2.4–5.4%).

Conclusions

Five-year and 10-year survival rates were 40% and 24%, respectively, following diabetic foot amputations. Higher age ≥70 years was associated with lower survival rate compared with younger age groups after lower extremity amputations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. S.C. Mishra, K.C. Chhatbar, A. Kashikar, A. Mehndiratta, Diabetic foot. BMJ 359, j5064 (2017). https://doi.org/10.1136/bmj.j5064

    Article  PubMed  PubMed Central  Google Scholar 

  2. D.G. Armstrong, A.J.M. Boulton, S.A. Bus, Diabetic foot ulcers and their recurrence. N. Engl. J. Med. 376(24), 2367–2375 (2017). https://doi.org/10.1056/NEJMra1615439

    Article  PubMed  Google Scholar 

  3. M.B. Brennan, T.M. Hess, B. Bartle, J.M. Cooper, J. Kang, E.S. Huang, M. Smith, M.W. Sohn, C. Crnich, Diabetic foot ulcer severity predicts mortality among veterans with type 2 diabetes. J. Diabetes Complications 31(3), 556–561 (2017). https://doi.org/10.1016/j.jdiacomp.2016.11.020

    Article  PubMed  Google Scholar 

  4. N. Tentolouris, S. Al‐Sabbagh, M.G. Walker, A.J. Boulton, E.B. Jude, Mortality in diabetic and nondiabetic patients after amputations performed from 1990 to 1995: a 5‐year follow‐up study. Diabetes Care 27(7), 1598–1604 (2004). https://doi.org/10.2337/diacare.27.7.1598

    Article  PubMed  Google Scholar 

  5. P.W. Moxey, P. Gogalniceanu, R.J. Hinchliffe, I.M. Loftus, K.J. Jones, M.M. Thompson, P.J. Holt, Lower extremity amputations—a review of global variability in incidence. Diabet. Med. 28(10), 1144–1153 (2011). https://doi.org/10.1111/j.1464-5491.2011.03279.x

    Article  CAS  PubMed  Google Scholar 

  6. D.J. Margolis, W. Jeffcoate, Epidemiology of foot ulceration and amputation: can global variation be explained? Med. Clin. North Am. 97(5), 791–805 (2013). https://doi.org/10.1016/j.mcna.2013.03.008

    Article  PubMed  Google Scholar 

  7. A.J. Boulton, The pathway to foot ulceration in diabetes. Med. Clin. North Am. 97(5), 775–790 (2013). https://doi.org/10.1016/j.mcna.2013.03.007

    Article  PubMed  Google Scholar 

  8. M. Kerr, G. Rayman, W.J. Jeffcoate, Cost of diabetic foot disease to the National Health Service in England. Diabet. Med. 31(12), 1498–1504 (2014). https://doi.org/10.1111/dme.12545

    Article  CAS  PubMed  Google Scholar 

  9. C.A. Behrendt, B. Sigvant, Z. Szeberin, B. Beiles, N. Eldrup, I.A. Thomson, M. Venermo, M. Altreuther, G. Menyhei, J. Nordanstig, M. Clarke, H.C. Rieß, M. Björck, E.S. Debus, International variations in amputation practice: a VASCUNET report. Eur. J. Vasc. Endovasc. Surg. 56(3), 391–399 (2018). https://doi.org/10.1016/j.ejvs.2018.04.017

    Article  PubMed  Google Scholar 

  10. L.N. McEwen, K.R. Ylitalo, M. Munson, W.H. Herman, J.S. Wrobel, Foot complications and mortality: results from translating research into action for diabetes (TRIAD). J. Am. Podiatr. Med. Assoc. 106(1), 7–14 (2016). https://doi.org/10.7547/14-115

    Article  PubMed  PubMed Central  Google Scholar 

  11. American Cancer Society. Cancer Facts & Figures 2013. (American Cancer Society, Atlanta, 2013), https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2013.html. Accessed 27 Oct 2019

  12. American Cancer Socitey. Colorectal Cancer Facts & Figures 2014–2016. (American Cancer Society, Atlanta, 2014). Accessed 27 Oct 2019

  13. M.E. López-Valverde, J. Aragón-Sánchez, A. López-de-Andrés, V. Guerrero-Cedeño, R. Tejedor-Méndez, G. Víquez-Molina, R. Jiménez-García, Perioperative and long-term all-cause mortality in patients with diabetes who underwent a lower extremity amputation. Diabetes Res. Clin. Pr. 141, 175–180 (2018). https://doi.org/10.1016/j.diabres.2018.05.004

    Article  Google Scholar 

  14. D.C. Jupiter, J.C. Thorud, C.J. Buckley, N. Shibuya, The impact of foot ulceration and amputation on mortality in diabetic patients. I: from ulceration to death, a systematic review. Int. Wound J. 13(5), 892–903 (2016). https://doi.org/10.1111/iwj.12404

    Article  PubMed  Google Scholar 

  15. A. López-de-Andrés, R. Jiménez-García, M.D. Esteban-Vasallo, V. Hernández-Barrera, J. Aragon-Sánchez, I. Jiménez-Trujillo, J. de Miguel-Diez, M.A. Palomar-Gallego, M. Romero-Maroto, N. Perez-Farinos, Time trends in the incidence of long-term mortality in T2DM patients who have undergone a lower extremity amputation. Results of a descriptive and retrospective cohort study. J. Clin. Med. 8(10), pii: E1597 (2019). https://doi.org/10.3390/jcm8101597

    Article  Google Scholar 

  16. Ü. Gök, Ö. Selek, A. Selek, A. Güdük, M.Ç. Güner, Survival evaluation of the patients with diabetic major lower-extremity amputations. Musculoskelet. Surg. 100(2), 145–148 (2016). https://doi.org/10.1007/s12306-016-0399-y

    Article  PubMed  Google Scholar 

  17. Y.Y. Huang, C.W. Lin, H.M. Yang, S.Y. Hung, I.W. Chen, Survival and associated risk factors in patients with diabetes and amputations caused by infectious foot gangrene. J. Foot Ankle Res. 11, 1 (2018). https://doi.org/10.1186/s13047-017-0243-0

    Article  PubMed  PubMed Central  Google Scholar 

  18. T.E. Wilbek, R.B. Jansen, B. Jørgensen, O.L. Svendsen, Risk factors for premature death in diabetes patients who undergo amputations below ankle level. Exp. Clin. Endocrinol. Diabetes 126(1), 61–65 (2018). https://doi.org/10.1055/s-0043-109700

    Article  CAS  PubMed  Google Scholar 

  19. P.J. Kelly, P.M. Clarke, A.J. Hayes, U.G. Gerdtham, J. Cederholm, P. Nilsson, B. Eliasson, S. Gudbjornsdottir, Predicting mortality in people with type 2 diabetes mellitus after major complications: a study using Swedish National Diabetes Register data. Diabet. Med. 31(8), 954–962 (2014). https://doi.org/10.1111/dme.12468

    Article  CAS  PubMed  Google Scholar 

  20. I. Desormais, V. Aboyans, A. Bura, J. Constans, J.P. Cambou, E. Messas, A. Labrunie, P. Lacroix, Anemia, an independent predictive factor for amputation and mortality in patients hospitalized for peripheral artery disease. Eur. J. Vasc. Endovasc. Surg. 48(2), 202–207 (2014). https://doi.org/10.1016/j.ejvs.2014.04.005

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Foundation Trust, Lancashire, UK

    Bernard Pac Soo, Satyan Rajbhandari, Ushank Ranasinghe & Joseph M. Pappachan

  2. Department of Vascular Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Lancashire, PR2 9HT, UK

    Ansy Egun

  3. Faculty of Education, Health and Wellbeing, University of Wolverhampton, Walsall, UK

    Ian M. Lahart

Authors
  1. Bernard Pac Soo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Satyan Rajbhandari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ansy Egun
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ushank Ranasinghe
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ian M. Lahart
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Joseph M. Pappachan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joseph M. Pappachan.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was performed as a retrospective clinical audit at the Lancashire Teaching Hospitals NHS Trust and the Institutional Review Board had approved this audit at the time of initiation of the study and agreed for publication of the results in biomedical periodicals.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Soo, B.P., Rajbhandari, S., Egun, A. et al. Survival at 10 years following lower extremity amputations in patients with diabetic foot disease. Endocrine 69, 100–106 (2020). https://doi.org/10.1007/s12020-020-02292-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-020-02292-7

Keywords

Search

Navigation