Prognosis after Lower Extremity Amputation in Patients with Diabetes (Original)

Objectives: To evaluate rates of mortality and second lower extremity amputation (LEA) in patients with diabetes and to investigate predictors of survival and second LEA.Design : A hospital-based retrospective cohort study.Patients: Forty-two patients with diabetes who had undergone LEA and 168 who had not at three university hospitals in Japan from 1993 through 1998.Methods: Follow-up until January 1, 2000, with clinical information abstracted from medical records.Results: The patients who had undergone LEA were 31 men and 11 women with a mean age of 65.2 years and an average duration of diabetes of 19.4 years.During follow-up,13 patients died and 13 underwent a second LEA.The crude mortality and second-LEA rates per 1,000 patientyears were 112.5 (95% confidence interval: 51.3 to 173.7) and 257.8 (147.6 to 368.1), respectively.The standardized mortality ratio was 5.4 (2.9 to 9.3).Life-table analysis showed that 1-year cumulative risks of death and second LEA were 20.0% (7.6% to 32.4%)and 27.6% (12.9% to 42.2%), respectively.M ultivariate Cox proportional hazard models showed hazard ratios of death of 5.1 (2.3 to 11.2),unadjusted,and 4.2 (1.7 to 10.2),adjusted,for age,sex,and known duration of diabetes, and 4.0 (0.9 to 17.3)further adjusted for a significant potential confounder among patients who had undergone LEA compared with those who had not.The co-morbidity remaining in the model was a history of stroke, with a relative risk of 4.6 (1.3 to 16.4).M ortality in patients undergoing LEA was significantly higher for those 60 years or older and those with a history of stroke.The second-LEA rate was significantly higher for patients receiving dialysis and patients with a history of stroke.Conclusions: Patients with diabetes are at high risk for LEA.Primary prevention of LEA is extremely important.(