title: Minor amputation does not negatively affect health-related quality of life as compared with conservative treatment in patients with a diabetic foot ulcer: An observational study.
abstract: Health-related quality of life (HRQoL) is poor in patients with persistent diabetic foot ulcers and poor HRQoL predicts worse outcomes in these patients. Amputation is often considered a treatment failure, which is why conservative treatment is generally preferred over amputation. However, it is unclear whether minor amputation negatively affects HRQoL compared with conservative treatment in patients with diabetic foot ulcers.
  
  
  
  In the cohort of the multicenter, prospective, observational Eurodiale study, we determined difference in change of HRQoL measured by EQ-5D between patients with a diabetic foot ulcers that healed after conservative treatment (n = 676) and after minor amputation (n = 145). Propensity score was used to adjust for known confounders, attempting to overcome lack of randomization.
  
  
  
  Baseline HRQoL was not significantly different between patients treated conservatively and undergoing minor amputation. In addition, there was no difference in the change of HRQoL between these groups. In patients who healed 6 to 12 months after the first visit, HRQoL on the anxiety/depression subscale even appeared to improve more in those who underwent minor amputation.
  
  
  
  Minor amputation was not associated with a negative impact on HRQoL in patients with a diabetic foot ulcers. It may therefore not be considered treatment failure in terms of HRQoL but rather a viable treatment option. A randomized controlled trial is warranted to further examine the influence of minor amputations on health-related quality of life.
authors: Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors: K
authors: K
authors: Pickwell
authors: The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors: V
authors: V
authors: Siersma
authors: Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors: M
authors: M
authors: Kars
authors: Department of Endocrinology, University of Malmö, Malmö, Sweden.
authors: J
authors: J
authors: Apelqvist
authors: IDF Consultative Section and International Working Group on the Diabetic Foot, Heemstede, the Netherlands.
authors: K
authors: K
authors: Bakker
authors: Diabetic Department, Kings College Hospital, London, United Kingdom.
authors: M
authors: M
authors: Edmonds
authors: Copenhagen Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark.
authors: P
authors: P
authors: Holstein
authors: Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors: A
authors: A
authors: Jirkovská
authors: Diabetes Centre, Tameside General Hospital, Ashton-under-Lyne, UK.
authors: E B
authors: EB
authors: Jude
authors: Department of Endocrinology and Nutrition, Hospital de Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
authors: D
authors: D
authors: Mauricio
authors: Sezione Dipartimentale Piede Diabetico, Dipartimento di Area Medica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors: A
authors: A
authors: Piaggesi
authors: Innere Abteilung, Mariannen Hospital, Werl, Germany.
authors: H
authors: H
authors: Reike
authors: Mathias-Spital, Diabetic Department, Rheine, Germany.
authors: M
authors: M
authors: Spraul
authors: Policlinico Tor Vergata, Department of Internal medicine, Rome, Italy.
authors: L
authors: L
authors: Uccioli
authors: Department of Endocrinology, University Medical Centre, Ljubljana, Slovenia.
authors: V
authors: V
authors: Urbancic
authors: H Familie Ziekenhuis and Centre de Santé des Fagnes, Department of Endocrinology, Rumst and Chimay, Belgium.
authors: K
authors: K
authors: van Acker
authors: Department of Surgery, Twenteborg Ziekenhuis, Almelo, The Netherlands.
authors: J
authors: J
authors: van Baal
authors: Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors: N
authors: N
authors: Schaper
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D000072700:Conservative Treatment; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D017719:Diabetic Foot / Q000209:etiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires
keywords: Euroqol 5D; diabetic foot ulcer; health-related quality of life; minor amputation