SLR - November 2023 - Minihane
Title: Outcomes after minor lower limb amputation for peripheral arterial disease and diabetes: population-based cohort studyReference: Birmpili P, Li Q, Johal AS, Atkins E, Waton S, Chetter I, Boyle JR, Pherwani AD, Cromwell DA. Outcomes after minor lower limb amputation for peripheral arterial disease and diabetes: population-based cohort study. Br J Surg. 2023 Jul 17;110(8):958-965. doi: 10.1093/bjs/znad134. PMID: 37216910; PMCID: PMC10361679.
Level of Evidence: 3
Reviewed By: Caitlyn Minihane DPM
Residency Program: Long Island Jewish Forest Hills
Podiatric Relevance: Peripheral arterial disease is the leading contributor of lower extremity amputations with more than 185,000 occurring yearly in the United States. 1 in 14 people live with diabetes and 1 in 5 aged over 80 years old live with PAD. Patients with minor amputations are at a higher risk of subsequent major amputation above the ankle. The purpose of the study was to evaluate the rate of re-amputations on ipsilateral limb, death after an initial minor amputation and to identify associated risk factors.
Methods: 823 patients aged 40 years and older with diabetes and/or peripheral arterial disease who underwent minor amputations between January 2014 and December 2018. Exclusion criteria included minor amputation 3 years before the study, bilateral minor amputation, trauma, cancer, musculoskeletal or connective tissue disorders. Information on type of amputation including emergency vs elective, level of amputation foot vs toe and presence of gangrene or osteomyelitis was recorded.
Results: The estimated ipsilateral major amputation rate was 10% in the first year after minor amputation with patients associated with PAD and diabetes mellitus. The estimated mortality rate was 17% at 1 year and 50% at 5 years after minor amputation. Patients associated with older age, more co-morbidities, presentation of gangrene, and emergency admission had a higher risk of death.
Conclusion: This study concluded that minor amputations were associated with a high risk of major amputation and death. 1 in 10 patients had a major amputation within the first year after minor amputation was performed and death occurred within the next 5 years. This study did not discuss if any patients were revascularized which I thought was a weakness. This study will allow me to educate my patients on the associated risks with amputation rates, keep a close eye on my post-operative amputation patients and to seek out a multidisciplinary approach including a supportive and well-equipped vascular team.