Ten-year survival of Finnish lower limb amputees

Abstract

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.

An enhanced treatment program with markedly reduced mortality after a transtibial or higher non-traumatic lower extremity amputation

“…However, we cannot exclude the possibility that the shorter hospital stay for patients from nursing homes (compared to patients living in their own home before admission) influenced their mortality rates. Also, we did see a tendency of higher mortality rates in patients with an index TFA amputation, as reported in other studies (Pohjolainen and Alaranta 1998 , Feinglass et al. 2001 , Stone et al.…”

“…Importantly, the differences in mortality rates observed among the different age groups in the intervention group might explain why age was not an independent risk factor when entered as a continuous variable in the multivariable Cox models. That is, older age is commonly associated with increased mortality rates following LEA (Pohjolainen and Alaranta 1998 , Feinglass et al. 2001 , Kristensen et al.…”

Very low survival rates after non-traumatic lower limb amputation in a consecutive series: what to do?

“…Having a lower limb amputation is associated with a somehow high risk of not surviving within the first year from surgery, with perioperative mortality ranging from 9 to 16% [1][2][3][4][5], and 1-year survival rates ranging from 86 to 53% [1][2][3][4][5][6][7][8][9][10]. The majority of nontraumatic amputations are most often caused by a vascular disease, followed by diabetes or a combination of both [1,4,5,[7][8][9], whereas worse survival rates have been associated with factors such as older age, diabetes, more than one co-morbidity, above knee amputations (AKAs), type of rehabilitation setting and the post-amputation physical independence grade [1,3,6,8,11,12]. Still, other studies found no difference between amputation levels and 1-year mobility [2] or mortality [5], and diabetic amputees seem less likely to die within 1-year than dysvascular amputees [7].…”

Care of elderly lower limb amputees, as described in medical and nursing records

“…It has been reported that the disability following LLA is permanent in elderly patients due to diabetes and other pathology in many organs (i.e. heart, brain, eye, kidney and nervous system), and that these patients therefore will be continuously dependent on health care services (7).…”