title: Survival evaluation of the patients with diabetic major lower-extremity amputations.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the survival after major lower-limb amputation, at a level either below (BKA) or above (AKA) the knee, in diabetic patients.
  
  
  METHODS
  A total of 140 diabetic patients who underwent major lower-limb amputation during the period of 2001-2011 were enrolled in the study. The patients were grouped as below-knee and above-knee amputations. The differences in survival by age, gender, amputation level and revision surgery were investigated. The clinical follow-up periods and the results of the patients with major lower-limb amputation were retrospectively assessed.
  
  
  RESULTS
  The mean follow-up period was 24.87 months (range 0.06-120 months). The mortality rate of series was 32.8 % for 1 year and 70 % for 5 years. One-year mortality rate was 24.6 % and 5-year mortality rate was 66.3 % in below-knee group, 1-year mortality rate was 43.3 % and 5-year mortality rate was 83.3 % in above-knee group. The difference between mortality rates of these groups was significant (p: 0.019). There was no statistically significant difference according to age and gender (p: 0.543 and 0.568). The previous minor amputations were found to have no effect on mortality (p: 0.471).
  
  
  CONCLUSIONS
  Routine utilization of diabetes follow-up, screening and treatment programs with a multidisciplinary approach might be mandatory to handle early multisystem involvement-prevent major amputation, and increase survival rate in diabetic patients.
  
  
  METHODS
  Retrospective cohort study, Level III.
authors.affiliation: Department of Orthopaedics and Traumatology, İzmit SEKA State Hospital, 41100, Kocaeli, Turkey. drumitgok@hotmail.com.
authors.forename: Ü
authors.initials: Ü
authors.lastname: Gök
authors.affiliation: Department of Orthopaedics and Traumatology, School of Medicine, Kocaeli University, Kocaeli, Turkey.
authors.forename: Ö
authors.initials: Ö
authors.lastname: Selek
authors.affiliation: Department of Endocrinology and Metabolism, School of Medicine, Kocaeli University, Kocaeli, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Selek
authors.affiliation: Department of Orthopaedics and Traumatology, Rize State Hospital, Rize, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Güdük
authors.affiliation: Department of Podiatry, School of Medicine, Acıbadem University, Istanbul, Turkey.
authors.forename: M Ç
authors.initials: MÇ
authors.lastname: Güner
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D015897:Comorbidity; D003646:Debridement; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000401:mortality; D017719:Diabetic Foot / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D007674:Kidney Diseases / Q000401:mortality; D007866:Leg / Q000098:blood supply / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D012086:Reoperation; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality; D012737:Sex Factors; D015996:Survival Rate; D014421:Turkey / Q000453:epidemiology
keywords: Diabetic foot amputation; Foot ulcers; Mortality; Survival analysis