Persistent Poor Survival Following Lower-Limb Amputation for Peripheral Artery Disease: A National Study

Lower-limb amputation remains a devastating outcome of peripheral artery disease (PAD). Over recent decades, advances in cardiovascular and PAD management, rising diabetes incidence, and population ageing may have influenced amputation incidence and outcomes. This nationwide study evaluates changes in incidence and short- and long-term survival after PAD-related lower-limb amputation in the Netherlands between 1995-1999 and 2014-2018.

Observational cohort study METHODS: Nationwide linked registry data from the Hospital Discharge Register, Population Register, and Cause of Death Register were used. Patients >45 years undergoing PAD-related amputations were included. Patient characteristics, amputation incidences, survival and causes of death were compared between periods.

A total of 30,400 unique patients were identified and analyzed. Over time the overall amputation incidence decreased with 16.3%, along with median age, the proportion of major amputations, and median hospital stay, whereas the proportion male patients and comorbidity burden, including diabetes, increased. Six-month survival rose from 75.6% to 83.4% (p<0.001) with male sex, hypertension, and diabetes as strong predictors of early mortality. Long-term survival (conditional on 6 months survival) remained poor with 5-year relative survival rates between 0.51 and 0.80, depending on diabetic status, sex, and amputation level. Excess mortality was extremely high, especially among younger and diabetic patients.

Short-term post-amputation survival has improved over time (2014-2018 versus 1995-1999). However, long-term outcomes remain poor, particularly in younger patients with diabetes and after major amputation. Amputation continues to identify a multimorbid population with advanced systemic vascular disease, necessitating improved prevention and treatment.