title: Five-year mortality for patients with end-stage renal disease who undergo upper extremity amputation.
abstract: OBJECTIVE
  To compare the 5-year survival rate of patients on dialysis requiring an upper extremity amputation with those who did not require such surgery and to analyze whether such an amputation was prognostic for mortality.
  
  
  METHODS
  The medical records of 20 consecutive patients with end-stage renal disease who received upper extremity amputations were reviewed. Control patients (n = 40) were matched based on age, sex, and duration of dialysis treatment. A Kaplan-Meier survival analysis was performed.
  
  
  RESULTS
  The mean survival time after the index surgery for the surgical group was 4.95 years ± 0.90 years, and the mean survival for the control group was 8.40 years ± 0.61 years. The probability of death (the event) was statistically greater in the surgical group. The overall 5-year survival rates for the surgical and the nonsurgical groups were 35% (7 of 20) and 70% (28 of 40), respectively. Patients with diabetes in the surgical group had a significantly lower 5-year survival rate, a greater number of amputations, and a greater number of wound-healing failures.
  
  
  CONCLUSIONS
  The 5-year survival rate from the index surgery of the surgical group was half that of the nonsurgical group. Increased mortality may be partially attributed to the poor vascular health of the patient. This analysis may help the hand surgeon to more effectively counsel patients with end-stage renal disease about the prognosis associated with an upper extremity amputation and, more importantly, supports the goal of timely intervention by the multidisciplinary team to optimize care planning and to improve surgical outcomes and quality of life.
  
  
  METHODS
  Prognostic III.
authors.affiliation: Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC; Azalea Orthopaedics & Sports Medicine, Tyler, TX.
authors.forename: Austin V
authors.initials: AV
authors.lastname: Stone
authors.affiliation: Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC; Azalea Orthopaedics & Sports Medicine, Tyler, TX.
authors.forename: N Michael
authors.initials: NM
authors.lastname: Xu
authors.affiliation: Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC; Azalea Orthopaedics & Sports Medicine, Tyler, TX.
authors.forename: Ryan W
authors.initials: RW
authors.lastname: Patterson
authors.affiliation: Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC; Azalea Orthopaedics & Sports Medicine, Tyler, TX.
authors.forename: L Andrew
authors.initials: LA
authors.lastname: Koman
authors.affiliation: Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC; Azalea Orthopaedics & Sports Medicine, Tyler, TX.
authors.forename: Beth P
authors.initials: BP
authors.lastname: Smith
authors.affiliation: Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC; Azalea Orthopaedics & Sports Medicine, Tyler, TX. Electronic address: zli@wakehealth.edu.
authors.forename: Zhongyu
authors.initials: Z
authors.lastname: Li
mesh_terms: D000671:Amputation, Surgical; D003925:Diabetic Angiopathies / Q000453:epidemiology; D005260:Female; D005385:Fingers / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy; D008297:Male; D011379:Prognosis; D006435:Renal Dialysis; D012189:Retrospective Studies; D012907:Smoking / Q000453:epidemiology; D034941:Upper Extremity / Q000601:surgery*
keywords: Amputation; diabetes; dialysis; survival; upper extremity