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Survival after lower-extremity amputation.
Diana Kovacich Sandnes1, Michael Sobel, David Reed Flum
1Department of Surgery, University of Washington, Seattle, WA 98195-6410, USA.
Journal of the American College of Surgeons
|August 25, 2004
Summary
Long-term survival after lower extremity amputation has improved significantly over time, although 30-day survival rates remain stable. Further research is needed to understand and enhance these survival gains in amputation patients.
Area of Science:
- Medical research
- Surgical outcomes
- Public health
Background:
- Lower extremity amputation was historically viewed as a terminal event.
- Uncertainty existed regarding improvements in post-amputation survival over time.
Purpose of the Study:
- To investigate whether survival rates after lower extremity amputation have improved over time.
- To analyze trends in amputation survival using a statewide database.
Main Methods:
- Retrospective cohort study using a statewide hospital discharge database (1987-2000).
- Included patients over 18 with non-traumatic lower extremity amputations.
- Survival analysis employed to determine adjusted hazard ratios related to amputation era.
Main Results:
- 13,807 patients (mean age 67, 58.5% male) underwent amputation.
- 49.2% of patients died during follow-up; proximal amputation levels correlated with worse outcomes.
- Patients undergoing amputation between 1995-2000 had a 28% lower hazard of dying compared to those before 1995.
- While 30-day survival was stable, 1- and 5-year survival significantly improved over time.
Conclusions:
- Long-term survival following lower extremity amputation has considerably improved.
- Thirty-day survival rates associated with amputation have remained stable.
- Further investigation is warranted to identify factors contributing to improved long-term survival.