Relative mortality in lower limb amputees with diabetes mellitus

Ebskov, Lars Bo

doi:10.3109/03093649609164436

Cited by 19 publications

(9 citation statements)

References 25 publications

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“…,One source of error is when no difference is made between minor and major amputations (Pohjolainen et al, 1989;Ebskov, 1996). This division is necessary due to differences regarding the amount of tissue trauma, the surgical technique, the postoperative treatment and the rehabilitation.…”

Section: Definitionsmentioning

confidence: 99%

From major amputation to prosthetic outcome

Johannesson

Larsson

Öberg

2004

Prosthetics &Amp; Orthotics International

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In this prospective study, the overall treatment and outcome of patients that underwent major lower limb amputation in a defined population is described. The study was performed over a five year period in the Health Care District of North-East Skåne, Sweden. Some 190 patients, permanent inhabitants of the Health Care District, underwent major lower limb amputation. Sixteen (16) of these patients had amputations before the study started and went through late second leg amputation during the period. One hundred and seventy four (174) patients had primary major amputation. Seventy nine (79) were men and 95 were women, with a median age of 81. The re-amputation rate was 17% although the primary knee preservation ratio was as high as 3.0:1. Rigid dressing was the standard method following trans-tibial amputation and was used for 5–7 days. ICEROSS∗ silicone liner was used for compression therapy in 90% of all cases that resulted in delivery of a prosthesis. Prostheses were delivered to 43% of all patients with primary amputations. These patients spent a median of 13 days at the orthopaedic clinic, 55 days at the rehabilitation unit. Pressure casting was used as a standard method in the production of the prosthetic socket. ICEX∗ carbon-fibre socket was used in 52%. New procedures, treatments and techniques were introduced, standardised and evaluated whilst the routines in the hospital were reorganised. In this way, a system has been implemented that better guarantees the outcome of the whole procedure and the service received by this category of patients.

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Section: Definitionsmentioning

confidence: 99%

From major amputation to prosthetic outcome

Johannesson

Larsson

Öberg

2004

Prosthetics &Amp; Orthotics International

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“…The majority of lower limb amputations performed in western society are on elderly people. The main condition leading to amputation is peripheral vascular disease and diabetes mellitus (Ebskov, 1996;Finch et al, 1980;Kolind-Sorensen, 1974;Pohjolainen and Alaranta, 1988;Stewart et al, 1992). In Finland trauma accounts for 2% (Pohjolainen and Alaranta, 1988) of lower limb amputations, in Denmark for 4% (Ebskov, 1988) and in Britain for 9% (Coddington, 1988).…”

Section: Introductionmentioning

confidence: 99%

Ten-year survival of Finnish lower limb amputees

Pohjolainen

Alaranta

1998

Prosthetics &Amp; Orthotics International

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Data on mortality for the ten years following lower limb amputation were obtained from all the 16 surgical units in Southern Finland and the National Social Insurance Institution. In Southern Finland during the period 1984-1985, amputations of the lower limb were performed on 705 patients, of whom 382 (54%) were women and 323 (46%) men. The majority of the amputations, 47%, were performed for vascular diseases and 41% were performed for diabetes mellitus. The overall survival was 62% at one year after amputation, 49% at two years, 27% at five years and 15% at ten years. The median survival after amputation was 1 yr 5 mth for the women and 2 yr 8 mth for the men. Of the arteriosclerotics, 43% died within one postoperative year while 43% lived longer than two years and 23% longer than five years. The median survival of arteriosclerotics was 1 yr 6 mth. The corresponding figure for patients with diabetes was 1 yr 11 mth. Of the diabetics, 38% died within one postoperative year while 47% lived longer than two years and 20% longer than five years. Of the trauma patients, 86% lived longer than five years and 71% longer than ten years. Of the trans-femoral amputees, 54% lived longer than one year, 36% over two years, 18% over five years and 8% over ten years. The corresponding figures for trans-tibial amputees were 70%. 53%, 21% and 4%. Many elderly vascular and diabetic patients undergoing amputation have a reduced physiological reserve and high mortality. The more proximal the amputation, the greater the risk that the patient will never be able to walk or that the duration of use of the prosthesis will be short. If a prosthesis seems to be a reasonable option for the elderly amputee, any delays in prosthetic fitting should be avoided in older age groups.

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“…Increased risk of mortality in type 1 diabetic individuals with a baseline history of LEA as compared to those without LEA was observed in the WHO Multinational Study of Vascular Disease in Diabetes [ 20 ]. The Danish Amputation Register, including 1406 type 1 diabetic patients, reported higher rate of mortality in patients with LEA as compared to those without, particularly during the first year following the amputation [ 31 ]. A history of LEA was also reported as an independent predictor for 5-year mortality in 1444 patients with type 1 diabetes from the Early Treatment Diabetic Retinopathy Study [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Lower-extremity amputation as a marker for renal and cardiovascular events and mortality in patients with long standing type 1 diabetes

Mohammedi

Potier

Belhatem

et al. 2016

Cardiovasc Diabetol

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BackgroundWe evaluated the risks of renal and cardiovascular complications, and mortality associated with lower extremity amputation (LEA) in patients with type 1 diabetes.MethodsWe studied two cohorts of people with long standing type 1 diabetes: GENEDIAB (n = 456) and GENESIS (n = 611). Subsets of the cohorts (n = 260, n = 544) were followed for 9 and 5 years, respectively. Outcomes were the incidence of end stage renal disease (ESRD), myocardial infarction, stroke and mortality during follow-up. Analyses were performed in pooled cohorts.ResultsThe prevalence of LEA at baseline was 9.3 % (n = 99). A positive history of LEA was associated with the baseline prevalence of established (OR 4.50, 95 % CI 2.33–8.91, p < 0.0001) and advanced diabetic nephropathy (OR 5.50, 95 % CI 2.89–10.78, p < 0.0001), ESRD (OR 2.86, 95 % CI 1.43–5.50, p = 0.004), myocardial infarction (OR 3.25, 95 % CI 1.68–6.15, p = 0.0006) and stroke (OR 3.88, 95 % CI 1.67–8.72, p = 0.002, adjusted for sex, age, and cohort membership). A positive history of LEA at baseline was associated with the incidence during follow-up of ESRD (HR 2.69, 95 % CI 1.17–6.20, p = 0.02), and myocardial infarction (HR 3.53, 95 % CI 1.79–6.97, p = 0.0001). History of LEA was also associated with increased risk for all-cause (HR 3.55, 95 % CI 2.05–6.16, p < 0.0001), cardiovascular (HR 3.30, 95 % CI 1.36–8.02, p = 0.008), infectious disease (HR 5.18, 95 % CI 1.13–23.84, p = 0.03) and other-cause mortality (HR 2.81, 95 % CI 1.09–7.26, p = 0.03). History of LEA at baseline was associated with a 40 % reduction in the duration of survival in the subset of patients who died during follow-up. Population attributable risk of the history of LEA at baseline for total mortality during follow-up was 0.31.ConclusionsPatients with LEA have a higher risk of ESRD, myocardial infarction and cardiovascular and non-cardiovascular mortality. Our results highlight the importance of LEA as a key-predictor for major vascular events and premature death in type 1 diabetic patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12933-015-0322-0) contains supplementary material, which is available to authorized users.

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Relative mortality in lower limb amputees with diabetes mellitus

Cited by 19 publications

References 25 publications

From major amputation to prosthetic outcome

From major amputation to prosthetic outcome

Ten-year survival of Finnish lower limb amputees

Lower-extremity amputation as a marker for renal and cardiovascular events and mortality in patients with long standing type 1 diabetes

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