All-cause mortality after diabetes-related amputation in Barbados: a prospective case-control study

doi:10.2337/dc08-1504

All-cause mortality after diabetes-related amputation in Barbados: a prospective case-control study

Ian R Hambleton, PHD (ian.hambleton{at}uwichill.edu.bb)1,
Ramesh Jonnalagadda, MS2,
Christopher R Davis, MB3,
Henry S Fraser, FRCP2,
Nish Chaturvedi, MD4 and
Anselm J Hennis, FRCP1,2

(1) Chronic Disease Research Centre, Tropical Medicine Research Institute, The University of the West Indies, Barbados
(2) Faculty of Medical Sciences, The University of the West Indies, Barbados
(3) Faculty of Medicine, University of Bristol, Bristol, UK
(4) International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College, London, UK

Abstract

Objective To determine the mortality rate after diabetes-related lower extremity amputation (LEA) in an African-descent Caribbean population.

Research design and methods A prospective case-control study. We recruited cases (diabetes and LEA), and age-matched controls (diabetes no LEA) in 1999–2001. We followed these groups for five-years to assess mortality risk and causes.

Results There were 205 amputations (123 minor, 82 major). One and five-year survival rates were 69% and 44% among cases, and 97% and 82% among controls (case-control difference, p<0.001). Mortality rates (per 1000 person years) were 273.9 (95% confidence interval 207.1 – 362.3) after a major amputation, 113.4 (85.2–150.9) after a minor amputation, and 36.4 (25.6–51.8) among controls. Sepsis and cardiac disease were the most common causes of death.

Conclusions These mortality rates are the highest reported worldwide. Interventions to limit sepsis and complications from cardiac disease offer a huge potential for improving post-LEA survival in this vulnerable group.