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High Mortality for Lower Limb Amputation

by U.S. Medicine

November 13, 2016

TEMPLE, TX—While high mortality rates have been reported after major amputations of a lower limb secondary to diabetes and peripheral vascular disease, the mortality rates have varied across studies.

A systematic review of the five-year mortality after nontraumatic major amputations of the lower extremity was conducted, with results published in the Journal of Foot and Ankle Surgery.1

A study team led by podiatrists from the Central Texas VA Health Care System performed a Medline data search using OVID, CINHAL and Cochrane. After 365 abstracts were screened, 79 full text articles were assessed for eligibility; 31 studies met the inclusion and exclusion criteria.

Results indicate that, overall, the five-year mortality rate was very high among patients with any amputation, whether major or minor combined, ranging from 53% to 100%, and in patients with major amputations, ranging from 52% to 80%.

The review noted that mortality after below-the-knee amputation ranged from 40% to 82% and from 40% to 90% after above-the-knee amputation.

Risk factors for increased mortality included age, renal disease, proximal amputation and peripheral vascular disease, according to the report.

“Although our previous systematic review of the five-year mortality after ulceration had much lower rates of death, additional studies are warranted to determine whether amputation hastens death or is a marker for underlying disease severity,” study authors concluded.

  1. Thorud JC, Plemmons B, Buckley CJ, Shibuya N, Jupiter DC. Mortality After Nontraumatic Major Amputation Among Patients With Diabetes and Peripheral Vascular Disease: A Systematic Review. J Foot Ankle Surg. 2016 May-Jun;55(3):591-9. doi: 10.1053/j.jfas.2016.01.012. Epub 2016 Feb 19. Review. PubMed PMID: 26898398.

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