title: Mortality in diabetic and nondiabetic patients after amputations performed from 1996 to 2005 in a tertiary hospital population: a 3-year follow-up study.
abstract: OBJECTIVE
  Diabetes is the leading cause of lower-extremity amputations worldwide. The objective of this study was to look at the survival after first amputation between subjects with and without diabetes in a sample of Greek population.
  
  
  METHODS
  We performed a retrospective study of all nontrauma, nonneoplasm-related amputations performed in a tertiary centre during the years 1996-2005 in diabetic (n=183) and nondiabetic patients (n=75). Survival status was assessed from the first amputation until December 31, 2005.
  
  
  RESULTS
  A total of 54.6% of amputees with diabetes and 51.6% of those without diabetes died in a mean [95% confidence interval (CI)] time of 4.3 (3.5-5.1) and 6.6 (4.6-8.6) years after the first amputation, respectively (P=.65). Diabetic patients underwent a second amputation (P=.003) and contralateral amputations (P=.02) more often in comparison with nondiabetic subjects. Predictors of all-cause mortality in the diabetic group, after adjustment for sex, were age [hazard ratio (HR) (95% CI), 1.04 (1.02-1.06); P<.001] and the level of amputation (major vs. minor) [HR, 1.55 (1.00-2.40), P=.05]. The respective values in the nondiabetic patients were HR of 1.06 (1.03-1.08; P<.001) and HR of 3.12 (1.27-7.64; P=.01). Median length of hospital stay was comparable between the two groups.
  
  
  CONCLUSIONS
  Mortality rates after amputation were high in both patients with and without diabetes. Older age and a higher level of amputation were associated with poorer survival. Diabetic patients more often underwent a second amputation to the same and the contralateral limb. Additionally, mortality rates, length of hospital stay, and perioperative mortality were not different between patients with and without diabetes.
authors.affiliation: 1st Department of Propaedeutic Medicine, Laiko Hospital, Athens University Medical Schoomicronl, Athens, Greece.
authors.forename: Athanasia
authors.initials: A
authors.lastname: Papazafiropoulou
authors.forename: Nicholas
authors.initials: N
authors.lastname: Tentolouris
authors.forename: Rigas-Philippos
authors.initials: RP
authors.lastname: Soldatos
authors.forename: Christos D
authors.initials: CD
authors.lastname: Liapis
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Dounis
authors.forename: Alkiviadis G
authors.initials: AG
authors.lastname: Kostakis
authors.forename: Elias
authors.initials: E
authors.lastname: Bastounis
authors.forename: Nicholas
authors.initials: N
authors.lastname: Katsilambros
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000671:Amputation, Surgical; D003920:Diabetes Mellitus / Q000401:mortality* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors