title: Clinical characteristics and survival of patients with diabetes mellitus following non-traumatic lower extremity amputation.
abstract: BACKGROUND
  Diabetes mellitus-related lower extremity amputation is a major complication severely affecting patient survival and quality of life.
  
  
  OBJECTIVE
  To analyze epidemiological and clinical trends in the incidence and survival of lower extremity amputations among diabetes patients.
  
  
  METHODS
  We conducted a retrospective observational cohort study of 565 consecutive diabetes patients who underwent their first non-traumatic lower extremity amputation between January 2002 and December 2009.
  
  
  RESULTS
  Major amputations were performed in 316 (55.9%) patients: 142 above the knee (25.1%) and 174 below (30.8%); 249 (44.1%) had a minor amputation. The incidence rates of amputations decreased from 2.9 to 2.1 per 1000 diabetes patients. Kaplan-Meier survival analysis showed that first year mortality rates were lower among patients with minor amputations (31.7% vs. 39.6%, P = 0.569). First year mortality rates following below-knee amputation were somewhat lower than above-knee amputation (33.1 vs. 45.1%, respectively). Cox regression model of survival at 1 year after the procedure found that age (HR 1.06 per year, 95% CI 1.04-1.07, P < 0.001), above-knee amputation (HR 1.36, 95% CI 1.01-1.83, P = 0.045) and ischemic heart disease (HR 1.68, 95% CI 1.26-2.24, P < 0.001) significantly increased one year mortality risk.
  
  
  CONCLUSIONS
  In this population-based study the incidence rate of non-traumatic amputations in diabetes patients between January 2002 and December 2009 decreased slightly. However, one year mortality rates after the surgery did not decline and remained high, stressing the need for a multidisciplinary effort to prevent amputations in diabetes patients.
authors.forename: Maya Paryente
authors.initials: MP
authors.lastname: Wiessman
authors.forename: Idit F
authors.initials: IF
authors.lastname: Liberty
authors.forename: Renana Wilkof
authors.initials: RW
authors.lastname: Segev
authors.forename: Tiberiu
authors.initials: T
authors.lastname: Katz
authors.forename: Muhammad
authors.initials: M
authors.lastname: Abu Tailakh
authors.forename: Victor
authors.initials: V
authors.lastname: Novack
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D015331:Cohort Studies; D015897:Comorbidity; D017719:Diabetic Foot / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000523:psychology; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate