Persistent Poor Survival Following Lower-Limb Amputation for Peripheral Artery Disease: A National Study
Annals of Vascular Surgery, vol. 133, pp. 409–419
Abstract
BACKGROUND: 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 aging may have influenced amputation incidence and outcomes. This nationwide observational cohort study evaluates changes in incidence and short-term and long-term survival after PAD-related lower-limb amputation in the Netherlands between 1995-1999 and 2014-2018. 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. RESULTS: 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. CONCLUSION: Short-term postamputation 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.
Authors 7
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Leiden University · Leiden University Medical Center
Affiliation as printed
Department of Vascular Surgery, Leiden University Medical Centre, Leiden, Netherlands. Electronic address: a.h.m.peeters@lumc.nl
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Leiden University · Leiden University Medical Center
Affiliation as printed
Department of Vascular Surgery, Leiden University Medical Centre, Leiden, Netherlands
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Leiden University · Leiden University Medical Center
Affiliation as printed
Department of Vascular Surgery, Leiden University Medical Centre, Leiden, Netherlands
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Leiden University · Leiden University Medical Center
Affiliation as printed
Department of Vascular Surgery, Leiden University Medical Centre, Leiden, Netherlands
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Leiden University · Leiden University Medical Center
Affiliation as printed
Department of Vascular Surgery, Leiden University Medical Centre, Leiden, Netherlands
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Leiden University · Leiden University Medical Center
Affiliation as printed
Department of Vascular Surgery, Leiden University Medical Centre, Leiden, Netherlands
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Leiden University · Leiden University Medical Center
Affiliation as printed
Department of Vascular Surgery, Leiden University Medical Centre, Leiden, Netherlands
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