title: Long-term mortality after lower-limb amputation.
abstract: BACKGROUND
  Mortality after amputation is known to be extremely high and is associated with a number of patient features. We wished to calculate this mortality after first-time lower-limb amputation and investigate whether any population or treatment factors are associated with worse mortality.
  
  
  OBJECTIVE
  To follow up individuals after lower limb amputation and ascertain the mortality rate as well as population or treatment features associated with mortality.
  
  
  METHODS
  A prospective cohort study.
  
  
  METHODS
  Prospective lower-limb amputations over 1 year (N = 105) at a Regional Rehabilitation Centre were followed up for 3 years.
  
  
  RESULTS
  After 3 years, 35 individuals in the cohort had died, representing a mortality of 33%. On initial univariate analysis, those who died were more likely to have diabetes mellitus (χ(2) = 7.16, df = 1, p = 0.007) and less likely to have been fitted with a prosthesis (χ(2) = 5.84, df = 1, p = 0.016). There was no association with age, gender, level of amputation, social isolation, significant medical co-morbidity other than diabetes or presence of mood disorders. A multi-variable logistic regression (backward step) confirmed that diabetes (odds ratio = 3.04, confidence intervals = 1.25-7.40, p = 0.014) and absence of prosthesis-fitting (odds ratio = 2.60, confidence interval = 1.16-6.25, p = 0.028) were independent predictors of mortality.
  
  
  CONCLUSIONS
  Mortality after amputation is extremely high and is increased in individuals with diabetes or in those who are not fitted with a prosthesis after amputation.
  
  
  CONCLUSIONS
  The link between diabetes and mortality after amputation has been noted by others, but this is the first study to find an effect from prosthetic limb-wearing. This requires further investigation to ascertain why the wearing of a prosthetic limb, confers an independent survival benefit that is not related to the presence of medical co-morbidity.
authors.affiliation: Osborn Unit, Northern General Hospital, Sheffield Teaching Hospitals, Sheffield, UK rajiv.singh@sth.nhs.uk.
authors.forename: Rajiv Kumar
authors.initials: RK
authors.lastname: Singh
authors.affiliation: Osborn Unit, Northern General Hospital, Sheffield Teaching Hospitals, Sheffield, UK.
authors.forename: Guru
authors.initials: G
authors.lastname: Prasad
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000401:mortality*; D001186:Artificial Limbs; D048909:Diabetes Complications / Q000150:complications / Q000401:mortality; D005260:Female; D006801:Humans; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017755:Prosthesis Fitting; D012307:Risk Factors; D015996:Survival Rate
keywords: Amputation; diabetes mellitus; lower limb; outcome studies; prosthesis