The impact of diabetes on mortality rates after lower extremity amputation.
Belgium
amputation
diabetes mellitus
lower extremity amputation
mortality
Journal
Diabetic medicine : a journal of the British Diabetic Association
ISSN: 1464-5491
Titre abrégé: Diabet Med
Pays: England
ID NLM: 8500858
Informations de publication
Date de publication:
Jan 2024
Jan 2024
Historique:
revised:
16
05
2023
received:
31
01
2023
accepted:
23
05
2023
pubmed:
25
5
2023
medline:
25
5
2023
entrez:
25
5
2023
Statut:
ppublish
Résumé
To assess the impact of diabetes, amputation level, sex and age on mortality rates after lower extremity amputation (LEA) in Belgium, and to assess temporal trends in one-year survival rates from 2009 to 2018. Nationwide data on individuals who underwent minor and major LEA from 2009 to 2018 were collected. Kaplan-Meier survival curves were constructed. A Cox regression model with time-varying coefficients was used to estimate the likelihood of mortality after LEA in individuals with or without diabetes. Matched amputation-free individuals with or without diabetes were used for comparison. Time trends were analysed. Amputations 41,304 were performed: 13,247 major and 28,057 minor. Five-year mortality rates in individuals with diabetes were 52% and 69% after minor and major LEA, respectively (individuals without diabetes: 45% and 63%, respectively). In the first six postoperative months, no differences in mortality rates were found between individuals with or without diabetes. Later, hazard ratios (HRs) for mortality in individuals with diabetes (compared with no diabetes) after minor LEA ranged from 1.38 to 1.52, and after major LEA from 1.35 to 1.46 (all p ≤ 0.005). Among individuals without LEA, HRs for mortality in diabetes (versus no diabetes) were systematically higher compared to the HRs for mortality in diabetes (versus no diabetes) after minor and major LEA. One-year survival rates did not change for individuals with diabetes. In the first six postoperative months, mortality rates after LEA were not different between individuals with or without diabetes; later, diabetes was significantly associated with increased mortality. However, as HRs for mortality were higher in amputation-free individuals, diabetes impacts mortality less in the minor and major amputation groups relative to the comparison group of individuals without LEA.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e15152Investigateurs
Isabelle Dumont
(I)
Patricia Felix
(P)
Giovanni Matricali
(G)
Informations de copyright
© 2023 Diabetes UK.
Références
van Netten JJ, Fortington LV, Hinchliffe RJ, Hijmans JM. Early post-operative mortality after major lower limb amputation: a systematic review of population and regional based studies. Eur J Vasc Endovasc Surg. 2015;51(2):248-257. doi:10.1016/j.ejvs.2015.10.001
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;55(3):591-599. doi:10.1053/j.jfas.2016.01.012
Meshkin DH, Zolper EG, Chang K, et al. Long-term mortality after nontraumatic major lower extremity amputation: a systematic review and meta-analysis. J Foot Ankle Surg. 2021;60(3):567-576. doi:10.1053/j.jfas.2020.06.027
Dillon MP, Quigley M, Fatone S. Outcomes of dysvascular partial foot amputation and how these compare to transtibial amputation: a systematic review for the development of shared decision-making resources. Syst Rev. 2017;6(1):54. doi:10.1186/s13643-017-0433-7
Yammine K, Hayek F, Assi C. A meta-analysis of mortality following minor amputation among patients with diabetes and/or peripheral vascular disease. J Vasc Surg. 2020;72(6):2197-2207. doi:10.1016/j.jvs.2020.07.086
Stern JR, Wong CK, Yerovinkina M, et al. A meta-analysis of long-term mortality and associated risk factors following lower extremity amputation. Ann Vasc Surg. 2017;42:322-327. doi:10.1016/j.avsg.2016.12.015
Armstrong DG, Swerdlow MA, Armstrong AA, Conte MS, Padula WV, Bus SA. Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer. J Foot Ankle Res. 2020;13(1):16. doi:10.1186/s13047-020-00383-2
Ambler GK, Thomas-Jones E, Edwards AGK, Twine CP. Prognostic risk modelling for patients undergoing major lower limb amputation: an analysis of the UK national vascular registry. Eur J Vasc Endovasc Surg. 2020;59(4):606-613. doi:10.1016/j.ejvs.2019.12.006
Amadou C, Denis P, Cosker K, Fagot-Campagna A. Less amputations for diabetic foot ulcer from 2008 to 2014, hospital management improved but substantial progress is still possible: a French nationwide study. PLoS ONE. 2020;15(11):e0242524. doi:10.1371/journal.pone.0242524
Aziz F, Reichardt B, Sourij C, et al. Epidemiology of major lower extremity amputations in individuals with diabetes in Austria, 2014-2017: a retrospective analysis of health insurance database. Diabetes Res Clin Pract. 2020;170:108477. doi:10.1016/j.diabres.2020.108477
Cascini S, Agabiti N, Davoli M, et al. Survival and factors predicting mortality after major and minor lower-extremity amputations among patients with diabetes: a population-based study using health information systems. BMJ Open Diabetes Res Care. 2020;8(1):e001355. doi:10.1136/bmjdrc-2020-001355
Hoffstad O, Mitra N, Walsh J, Margolis D. Diabetes, lower-extremity amputation, and death. Diabetes Care. 2015;38(10):1852-1857. doi:10.2337/dc15-0536
Lopez-de-Andres A, Jiménez-Garcia R, Aragon-Sanchez J, et al. National trends in incidence and outcomes in lower extremity amputations in people with or without diabetes in Spain, 2001-2012. Diabetes Res Clin Pract. 2015;108(3):499-507. doi:10.1016/j.diabres.2015.01.010
Icks A, Scheer M, Morbach S, et al. 2011. Time-dependent impact of diabetes on mortality in patients after major lower extremity amputation. Diabetes Care. 2011;34(6):1350-1354. doi:10.2337/dc10-2341
Malyar NM, Freisinger E, Meyborg M, et al. Low rates of revascularization and high in-hospital mortality in patients with ischemic lower limb amputation: morbidity and mortality of ischemic amputation. Angiology. 2016;67(9):1-10. doi:10.1177/0003319715626849
Buggy A, Moore Z. The impact of the multidisciplinary team in the management of individuals with diabetic foot ulcers: a systematic review. J Wound Care. 2017;26(6):324-339. doi:10.12968/jowc.2017.26.6.324
Lauwers P, Wouters K, Vanoverloop J, et al. to 2018. Diabetes Res Clin Pract. 2009;2022(189):109972. doi:10.1016/j.diabres.2022.109972
Moxey PW, Hofman D, Hinchliffe RJ, Jones K, Thompson MM, Holt PJE. Epidemiological study of lower limb amputation in England between 2003 and 2008. Br J Surg. 2010;97(9):1348-1353. doi:10.1002/bjs.7092
Wu H, Yang A, Lau ESH, et al. Secular trends in rates of hospitalization for lower extremity amputation and 1 year mortality in people with diabetes in Hong Kong, 2001-2016: a retrospective cohort study. Diabetologia. 2020;63(12):2689-2698. doi:10.1007/s00125-020-05278-2
Scohy A, Renard F, Jurcevic J. Atlas of cause-specific all-ages mortality by district in Belgium, 2010-2017. Available from 2017. https://www.healthybelgium.be/images/hsr/maps_0_99_2010_2017.pdf
Saluja S, Anderson SG, Hambleton I, et al. Foot ulceration and its association with mortality in diabetes mellitus: a meta-analysis. Diabet Med. 2020;37(2):211-218. doi:10.1111/dme.14151
Mayfield JA, Reiber GE, Maynard C, Czerniecki JM, Caps MT, Sangerozan BJ. Survival following lower-limb amputation in a veteran population. J Rehabil Res Dev. 2001;38(3):341-345.
Huxley RR, Peters SAE, Mishra GD, Woodward M. Risk of all-cause mortality and vascular events in women versus men with type 1 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2015;3(3):198-206. doi:10.1016/S2213-8587(14)70248-7
Xu G, You D, Wong L, et al. Risk of all-cause and CHD mortality in women versus men with type 2 diabetes: a systematic review and meta-analysis. Eur J Endocrinol. 2019;180(4):243-255. doi:10.1530/EJE-18-0792
Wang Y, O'Neil A, Jiao Y, et al. Sex differences in the association between diabetes and risk of cardiovascular disease, cancer, and all-cause and cause-specific mortality: a systematic review and meta-analysis of 5,162,654 participants. BMC Med. 2019;17(1):136. doi:10.1186/s12916-019-1355-0
Yang JJ, Yu D, Wen W, et al. Association of diabetes with all-cause and cause-specific mortality in Asia: a pooled analysis of more than 1 million participants. JAMA Netw Open. 2019;2(4):e192696. doi:10.1001/jamanetworkopen.2019.2696
Prospective Studies Collaboration and Asia Pacific Cohort Studies Collaboration. Sex-specific relevance of diabetes to occlusive vascular and other mortality: a collaborative meta-analysis of individual data from 980 793 adults from 68 prospective studies. Lancet Diabetes Endocrinol. 2018;6(7):538-546. doi:10.1016/S2213-8587(18)30079-2
Wu YT, Niubo AS, Daskalopoulou C, et al. Sex differences in mortality: results from a population-based study of 12 longitudinal cohorts. CMAJ. 2021;193:E361-E370. doi:10.1503/cmaj.200484
Healthy Belgium. General Mortality. Available from www.healthybelgium.be/en/health-status/mortality-and-causes-of-death/general-mortality
Ali MK, Pearson-Stuttard J, Selvin E, Gregg EW. Interpreting global trends in type 2 diabetes complications and mortality. Diabetologia. 2022;65(1):3-13. doi:10.1007/s00125-021-05585-2