title: Mortality After Nontraumatic Major Amputation Among Patients With Diabetes and Peripheral Vascular Disease: A Systematic Review.
abstract: High mortality rates have been reported after major amputations of a lower limb secondary to diabetes and peripheral vascular disease. However, the mortality rates have varied across studies. A systematic review of the 5-year mortality after nontraumatic major amputations of the lower extremity was conducted. A data search was performed of Medline using OVID, CINHAL, and Cochrane, 365 abstracts were screened, and 79 full text articles were assessed for eligibility. After review, 31 studies met the inclusion and exclusion criteria. Overall, the 5-year mortality rate was very high among patients with any amputation (major and minor combined), ranging from 53% to 100%, and in patients with major amputations, ranging from 52% to 80%. Mortality after below-the-knee amputation ranged from 40% to 82% and after above-the-knee amputation from 40% to 90%. The risk factors for increased mortality included age, renal disease, proximal amputation, and peripheral vascular disease. Although our previous systematic review of the 5-year mortality after ulceration had much lower rates of death, additional studies are warranted to determine whether amputation hastens death or is a marker for underlying disease severity.
authors.affiliation: Podiatrist, Section of Podiatry, Department of Surgery, Central Texas Veterans Affairs Health Care System, Temple, TX; Podiatrist, Department of Surgery, Baylor Scott & White Health, Temple, TX. Electronic address: jthorud@sw.org.
authors.forename: Jakob C
authors.initials: JC
authors.lastname: Thorud
authors.affiliation: Podiatrist, Section of Podiatry, Department of Surgery, Central Texas Veterans Affairs Health Care System, Temple, TX; Third Year Resident, Baylor Scott & White Health, Temple, TX; and Department of Surgery, Texas A&M Health Science Center, College of Medicine, Temple, TX.
authors.forename: Britton
authors.initials: B
authors.lastname: Plemmons
authors.affiliation: Chief, Department of Surgery, Central Texas Veterans Affairs Health Care System, Temple, TX; Director, Division of Surgery, Baylor Scott & White Health, Temple, TX; and Professor, Department of Surgery, Texas A&M Health Science Center, College of Medicine, Temple, TX.
authors.forename: Clifford J
authors.initials: CJ
authors.lastname: Buckley
authors.affiliation: Associate Professor, Department of Surgery, Texas A&M Health Science Center, College of Medicine, Temple, TX; Chief, Section of Podiatry, Department of Surgery, Central Texas Veterans Affairs Health Care System, Temple, TX; and Podiatrist, Baylor Scott & White Health, Temple, TX.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Shibuya
authors.affiliation: Assistant Professor, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Jupiter
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000379:methods / Q000401:mortality*; D002423:Cause of Death; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D011379:Prognosis; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis
keywords: above-the-knee amputation; below-the-knee amputation; death; renal disease; survival