Lower Extremity Amputee Outcomes with Reference to Co-morbidities

Background: Lower extremity amputation related to diabetes is a serious outcome, which can have devastating effects on the patient and family. The epidemiology of amputations has recently been used as a possible measure of the adequacy of medical prevention and treatment of diabetes and diabetic foot complications. Objectives: To report on patients undergoing amputations at one medical center in Israel, their co-morbidities, and the outcomes. Methods: A retrospective chart study was conducted of amputees operated between 1 September 2017 and 30 September 2018. Results: The study population comprised 72 patients who had major amputations for diabetes and/or ischemia, mean age 72 +/- 10 years, 74% males, 93% with type 2 diabetes. Mean age corrected Charlson Comorbidity Index was 8.2 +/- 2.1 with 90% (65 patients) presenting with a score of 6 or higher. Before the recent deterioration, fewer than 20% of the patients exited their home routinely and 24% had an official diagnosis of dementia. There were 31 below knee amputations (BKA) and 41 above knee amputations (AKA). The 30-day, 3-month, 1-year, and 2-year mortality rates were 15.3%, 27.8%, 43.1%, and 54.2% respectively. Median survival period was 20 months. Survival after AKA was 13.4 +/- 20, which was significantly less than after BKA (25.4 +/- 2.7, P = 0.097). Conclusions: Factors other than the quality of management of patients with diabetes and complications may contribute to amputation rates; thus, making speculations from international comparisons of raw amputation rates problematic. This population was less healthy than reported in most studies.