All-cause mortality after diabetes-related amputation in Barbados: a prospective case-control study.
OBJECTIVE
To determine the mortality rate after diabetes-related lower-extremity amputation (LEA) in an African-descent Caribbean population.


METHODS
We conducted a prospective case-control study. We recruited case subjects (with diabetes and LEA) and age-matched control subjects (with diabetes and no LEA) between 1999 and 2001. We followed these groups for 5 years to assess mortality risk and causes.


RESULTS
There were 205 amputations (123 minor and 82 major). The 1-year and 5-year survival rates were 69 and 44% among case subjects and 97 and 82% among control subjects (case-control difference, P < 0.001). The mortality rates (per 1,000 person-years) were 273.9 (95% CI 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 control subjects. 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.
Hambleton
Ian R
IR
Chronic Disease Research Centre, Tropical Medicine Research Institute, University of the West Indies, Barbados. ian.hambleton@uwichill.edu.bb
Jonnalagadda
Ramesh
R
Davis
Christopher R
CR
Fraser
Henry S
HS
Chaturvedi
Nish
N
Hennis
Anselm J
AJ
D000368:Aged; D000671:Amputation, Surgical / Q000145:classification / Q000401:mortality*; D001460:Barbados / Q000453:epidemiology; D044383:Black People / Q000706:statistics & numerical data; D016022:Case-Control Studies; D017719:Diabetic Foot / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications / Q000145:classification / Q000401:mortality; D011446:Prospective Studies; D015996:Survival Rate