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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

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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:

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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.