Mortality in Diabetic and Nondiabetic Patients After Amputations Performed From 1990 to 1995

A 5-year follow-up study

  1. Nicholas Tentolouris, MD,
  2. Sameer Al-Sabbagh, MRCP,
  3. Michael G. Walker, MD, FRCS,
  4. Andrew J.M. Boulton, MD, FRCP and
  5. Edward B. Jude, MD, FRCP
  1. From the University of Manchester, Department of Medicine, Manchester Royal Infirmary, Manchester, U.K
  1. Address correspondence and reprint requests to Dr. E.B. Jude, Diabetes Centre, Tameside General Hospital, Fountain Street, Ashton-under-Lyne, OL6 9RW, U.K. E-mail: edward.jude{at}tgh.nhs.uk

Abstract

OBJECTIVE—To compare survival rates after first amputation between patients with and without diabetes.

RESEARCH DESIGN AAND METHODS—We performed a retrospective study of all nontraumatic amputations performed at our center in the years 1990–1995 in patients with (n = 100) and without (n = 151) diabetes. Survival status was assessed from the first amputation until 31 December 2001.

RESULTS—Altogether, 61% of the patients with and 54.3% of those without diabetes died 5.2 (4.5–5.8) and 5.3 (4.7–5.9) [mean (95% CI)] years after the first amputation, respectively (P = 0.80). Survival was not different between patients with and without diabetes after controlling for the level (major versus minor) (P = 0.67) or the cause (ischemia versus infection) of amputation (P = 0.72). No sex differences were found for survival in either study group. Independent predictors of mortality in the diabetic group were duration of diabetes (P = 0.05), history of stroke (P = 0.02), and serum creatinine level (P < 0.0001), while in the nondiabetic group independent predictors were history of stroke (P = 0.04), serum creatinine level (P = 0.005), and higher white blood cell count (P = 0.02). The peak incidence of amputations was observed in the decade of 67–76 years of age in both groups. Major amputations were more common among nondiabetic patients in all age-groups. Median hospital stay and postoperative complications were comparable between the two groups.

CONCLUSIONS—All-cause mortality is high after an amputation in both diabetic and nondiabetic patients. Mortality rates, hospital stay, and postoperative complications are not different between diabetic and nondiabetic amputees. No modifiable factors, with the exception of nephropathy, were found to improve survival in amputees. Peripheral vascular disease and neuropathy are the main cause of amputations; prevention, therefore, of these complications is warranted to prevent amputations and the subsequent high mortality.

Footnotes

  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted April 5, 2004.
    • Received February 1, 2004.
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