Major lower extremity amputation in elderly patients with peripheral arterial disease: incidence and survival rates. Aging Clin Exp Res
Institute of Clinical Medicine, Department of Public Health, University of Turku, Turku, FI-20014, Finland. Aging clinical and experimental research
(Impact Factor: 1.22).
11/2008; 20(5):385-93. DOI: 10.1007/BF03325142
The methods of treating peripheral arterial disease (PAD) have changed and become more prophylactic. This study describes and analyzes 1) the incidence rates of major lower extremity amputation (LEA) due to PAD, 2) occurrence of re-amputation, and 3) the survival of amputees and factors predicting survival.
The series consisted of 210 patients (mean age 76.6, SD 10.7 yrs, 45.2% men) who underwent their first, i.e. index, major leg amputation because of PAD, in 1998-2002, in the city of Turku, Finland, population 175,000.
The age-and gender-standardized incidence rate of combined above-knee and below-knee amputations was 24.1/100,000 person-years during 1998-2002. Thirty-four per cent of amputees underwent repetitive amputation. One-month mortality was 21% (n=45), one-year mortality 52% (n=109) and overall mortality 80% (n=168). Cardiovascular diseases predicted equally well 31-day, one-year, and overall mortality in age- and gender- adjusted analysis. Multiple co-morbidities (p=0.023) and unilateral above-knee amputations (p=0.047) were significant predictors for overall mortality in age- and gender-adjusted analysis. Cardiovascular diseases remained a significant predictor for 31-day and overall mortality in multivariate analysis (p=0.008 and p=0.015, respectively). Amputated patients' previous vascular procedures did not have any effect on mortality in the Cox model. Most revascularizations were performed less than six months before the index/first major LEA.
Major LEAs seem to have been done late, and mainly for pain relief in the end-stage of patients with peripheral arterial disease.
Available from: Peter A Lazzarini
- "However, a recent 2011 review suggests global ranges of 6 to 31 per 100,000 in Italian and German populations respectively . Mortality rates for lower extremity amputations are reported to be higher than some cancers’ mortality rates ; in hospital mortality ranges between 2 – 19% [3,4,9,13], one-year mortality between 10 – 52% [4,7,13], and up to 80% mortality at five years [2,7,12,13]. "
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ABSTRACT: Lower extremity amputation results in significant global morbidity and mortality. Australia appears to have a paucity of studies investigating lower extremity amputation. The primary aim of this retrospective study was to investigate key conditions associated with lower extremity amputations in an Australian population. Secondary objectives were to determine the influence of age and sex on lower extremity amputations, and the reliability of hospital coded amputations.
Lower extremity amputation cases performed at the Princess Alexandra Hospital (Brisbane, Australia) between July 2006 and June 2007 were identified through the relevant hospital discharge dataset (n = 197). All eligible clinical records were interrogated for age, sex, key condition associated with amputation, amputation site, first ever amputation status and the accuracy of the original hospital coding. Exclusion criteria included records unavailable for audit and cases where the key condition was unable to be determined. Chi-squared, t-tests, ANOVA and post hoc tests were used to determine differences between groups. Kappa statistics were used to measure reliability between coded and audited amputations. A minimum significance level of p < 0.05 was used throughout.
One hundred and eighty-six cases were eligible and audited. Overall 69% were male, 56% were first amputations, 54% were major amputations, and mean age was 62 ± 16 years. Key conditions associated included type 2 diabetes (53%), peripheral arterial disease (non-diabetes) (18%), trauma (8%), type 1 diabetes (7%) and malignant tumours (5%). Differences in ages at amputation were associated with trauma 36 ± 10 years, type 1 diabetes 52 ± 12 years and type 2 diabetes 67 ± 10 years (p < 0.01). Reliability of original hospital coding was high with Kappa values over 0.8 for all variables.
This study, the first in over 20 years to report on all levels of lower extremity amputations in Australia, found that people undergoing amputation are more likely to be older, male and have diabetes. It is recommended that large prospective studies are implemented and national lower extremity amputation rates are established to address the large preventable burden of lower extremity amputation in Australia.
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ABSTRACT: Major lower extremity amputation (LEA) leads to great loss in mobility, exposing old people to the risk of losing their independent living status. This study applies predictors for institutionalization and considers prosthesis use by major lower leg amputees with peripheral arterial disease (PAD).
119 PAD patients admitted from home (mean age 73.6, SD 11.5 years, 48% men) underwent their first major LEA, 1998- 2002, and survived at least one month after the operation. Logistic regression analysis was run to clarify institutionalization predictors. Prosthesis use and ambulatory capacity were recorded during the follow-up.
Older age, living alone, and unilateral above-knee amputation (AKA) or bilateral amputation predicted institutionalization. Of prosthesis users, 69% (27/39) were younger than 75 and 44% (17/39) were able to walk both in- and outdoors. Reasons for not receiving a prosthesis after amputation were: 1) short expected survival; 2) old age, combined with unilateral AKA or bilateral amputation; 3) unilateral AKA or bilateral amputation and a comorbid condition such as hemiparesis, paraplegia, uremia, dementia, or alcohol misuse. After one year, 72% (36/50) of amputees who were able to return home and 9% (3/32) of amputees in institutional care used a prosthesis.
The majority of amputated patients cannot return home after their first LEA. Comorbid conditions particularly influencing functional capacity also hinder ambulation with a prosthesis.
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ABSTRACT: The purpose of this study was to assess the quality of life (QoL) of peripheral arterial disease (PAD) amputees.
Fifty-nine PAD patients (mean age 75.2, SD 10.7, range 39-96, 47% men) who had undergone their first major lower leg amputation (LEA) on average 2.7 years earlier (in 1998-2002) were interviewed, and 118 age- and gender-matched controls completed a postal questionnaire. Outcomes were assessed with 15D Health-Related QoL instrument, Rand-36 Physical Functioning- and General Health subscales, Geriatric Depression Scale, 6-item Brief Social Support Questionnaire, and Self-reported Life Satisfaction score.
The amputees had more diseases than their controls. HRQoL was lower among amputees than among controls. Half the amputees lived in institutional care, 25% had a Mini-Mental Examination score <18, and 22% had unilateral belowknee amputations only. The amputees had a similar self-assessed sense of their general state of health, life satisfaction and perceived social support as controls. Amputees who were institutionalized and those who did not use prostheses had more symptoms of depression than those who lived at home or used prostheses.
Home-dwelling amputees had a relatively good QoL, whereas institutionalization was associated with depressive symptoms. In rehabilitation programs, not only physical disability assessment but also QoL should be considered.
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