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

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.

Demographic and socioeconomic profiles of patients admitted with diabetic foot complications in a tertiary hospital in Belem - Para

“…Studies point to important factors that influence the diagnosis of diabetic foot, such as advanced age, type and time of diagnosis of DM, inadequate metabolic control, smoking, alcoholism, obesity, high blood pressure, and lack of good hygienic habits in foot care. Thus, a multifactorial and interdisciplinary approach is important to try to prevent or minimize its occurrence 1,2,4,[7][8][9] .…”

“…Diabetes mellitus (DM) is a chronic metabolic disease with persistent hyperglycemia, caused by hereditary and environmental factors, resulting from defects in the secretion or action of insulin, or both 1,2,3 . The disease can be classified into type 1 DM, with autoimmune origin, resulting from the destruction of pancreatic β-cells that causes complete insulin deficiency, and type 2 DM, characterized by insulin resistance 2,3 .…”

Autologous Peripheral Blood Mononuclear Cells for Limb Salvage in Diabetic Foot Patients with No-Option Critical Limb Ischemia

“…However, up to 25% of diabetic patients are not eligible for revascularization as a result of the inability to overcome vessel obstruction and/or for critical general conditions [3,4]. Of the one million annual amputations worldwide, 75% are performed on patients with type 2 diabetes (T2DM) [5]. No-option critical limb ischemia (NO-CLI) remains a strong unmet clinical need: at 1 year follow-up, NO-CLI diabetic patients showed, respectively, lower rates of limb salvage (13.8% vs. 73.4%, p < 0.0001), higher rates of amputation (30% vs. 4.5%, p = 0.0001), and higher mortality rates (50% vs. 8.9%, p < 0.0001) in comparison to revascularizable CLI patients [4].…”

Incidence and risk factors for poor perioperative blood glucose management in patients with diabetic foot: a retrospective study

“…A DF amputation can be major or minor, which mainly depends on the size of the lesion. However, because most patients with DF have poor blood glucose management and thus have varying degrees of damage to many organs, including the liver and kidney, the postoperative survival time of patients undergo amputation for DF is much shorter than that of diabetic patients without DF (10)(11)(12)(13). According to previous reports, the 5-year survival rate of patients with DF after amputation is only approximately 30-40% (10,13).…”