Quantification of the Survival Disadvantage Associated with Major Amputation in Patients with Peripheral Arterial Disease
Abstract
:1. Introduction
2. Methods
2.1. Study Design and Data Collection
2.2. Estimation of Life Expectancy
2.3. Analysis
3. Results
3.1. Patient Demographics
3.2. Treatment Characteristics and Postoperative Complications
3.3. Survival Times
3.4. Survival Penalty Associated with Major Amputation
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Ogaki, T.; Iida, O.; Hata, Y.; Yamauchi, N.; Yokoi, C.; Takahara, M.; Terashi, H.; Mano, T.; Asada, Y. The perioperative and long-term fates of patients with chronic limb-threatening ischaemia who underwent secondary major amputations. Int. Wound J. 2022, 19, 36–43. [Google Scholar] [CrossRef]
- Behrendt, C.A.; Sigvant, B.; Szeberin, Z.; Beiles, B.; Eldrup, N.; Thomson, I.A.; Venermo, M.; Altreuther, M.; Menyhei, G.; Nordanstig, J.; et al. International Variations in Amputation Practice: A VASCUNET Report. Eur. J. Vasc. Endovasc. Surg. 2018, 56, 391–399. [Google Scholar] [CrossRef] [PubMed]
- Aboyans, V.; Ricco, J.B.; Bartelink, M.L.E.L.; Björck, M.; Brodmann, M.; Cohnert, T.; Collet, J.P.; Czerny, M.; De Carlo, M.; Debus, S.; et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur. Heart J. 2018, 39, 763–816. [Google Scholar] [CrossRef] [PubMed]
- Nordanstig, J.; Behrendt, C.A.; Baumgartner, I.; Belch, J.; Bäck, M.; Fitridge, R.; Hinchliffe, R.; Lejay, A.; Mills, J.L.; Rother, U.; et al. Editor’s Choice—European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication. Eur. J. Vasc. Endovasc. Surg. 2024, 67, 9–96. [Google Scholar] [CrossRef] [PubMed]
- You, Y.; Wang, Z.; Yin, Z.; Bao, Q.; Lei, S.; Yu, J.; Xie, X. Global disease burden and its attributable risk factors of peripheral arterial disease. Sci. Rep. 2023, 13, 1–13. [Google Scholar] [CrossRef]
- Fowkes, F.G.R.; Rudan, D.; Rudan, I.; Aboyans, V.; Denenberg, J.O.; McDermott, M.M.; Norman, P.E.; Sampson, U.K.A.; Williams, L.J.; Mensah, G.A.; et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: A systematic review and analysis. Lancet 2013, 382, 1329–1340. [Google Scholar] [CrossRef] [PubMed]
- Mazzolai, L.; Teixido-Tura, G.; Lanzi, S.; Boc, V.; Bossone, E.; Brodmann, M.; Bura-Rivière, A.; De Backer, J.; Deglise, S.; Della Corte, A.; et al. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases: Developed by the task force on the management of peripheral arterial and aortic diseases of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS), the European Reference Network on Rare Multisystemic Vascular Diseases (VASCERN), and the European Society of Vascular Medicine (ESVM). Eur. Heart J. 2024, 45, 3538–3700. [Google Scholar] [CrossRef] [PubMed]
- Duff, S.; Mafilios, M.S.; Bhounsule, P.; Hasegawa, J.T. The burden of critical limb ischemia: A review of recent literature. Vasc. Health Risk Manag. 2019, 15, 187–208. [Google Scholar] [CrossRef]
- Pisa, G.; Reinhold, T.; Obi-Tabot, E.; Bodoria, M.; Brüggenjürgen, B. Critical limb ischemia and its impact on patient health preferences and quality of life-an international study. Int. J. Angiol. 2012, 21, 139–146. [Google Scholar] [CrossRef]
- Sprengers, R.W.; Teraa, M.; Moll, F.L.; De Wit, G.A.; Van Der Graaf, Y.; Verhaar, M.C. Quality of life in patients with no-option critical limb ischemia underlines the need for new effective treatment. J. Vasc. Surg. 2010, 52, 843–849. [Google Scholar] [CrossRef]
- Stern, J.R.; Wong, C.K.; Yerovinkina, M.; Spindler, S.J.; See, A.S.; Panjaki, S.; Loven, S.L.; D’Andrea, R.F.; Nowygrod, R. A Meta-analysis of Long-term Mortality and Associated Risk Factors following Lower Extremity Amputation. Ann. Vasc. Surg. 2017, 42, 322–327. [Google Scholar] [CrossRef] [PubMed]
- Höbaus, C.; Tscharre, M.; Herz, C.T.; Pesau, G.; Wrba, T.; Koppensteiner, R.; Schernthaner, G.H. YKL-40 levels increase with declining ankle-brachial index and are associated with long-term cardiovascular mortality in peripheral arterial disease patients. Atherosclerosis 2018, 274, 152–156. [Google Scholar] [CrossRef] [PubMed]
- Voci, D.; Fedeli, U.; Valerio, L.; Schievano, E.; Righini, M.; Kucher, N.; Spirk, D.; Barco, S. Mortality rate related to peripheral arterial disease: A retrospective analysis of epidemiological data (years 2008–2019). Nutr. Metab. Cardiovasc. Dis. 2023, 33, 516–522. [Google Scholar] [CrossRef] [PubMed]
- Aursulesei Onofrei, V.; Ceasovschih, A.; Marcu, D.T.M.; Adam, C.A.; Mitu, O.; Mitu, F. Mortality Risk Assessment in Peripheral Arterial Disease—The Burden of Cardiovascular Risk Factors over the Years: A Single Center’s Experience. Diagnostics 2022, 12, 2499. [Google Scholar] [CrossRef] [PubMed]
- Shah, S.K.; Bena, J.F.; Allemang, M.T.; Kelso, R.; Clair, D.G.; Vargas, L.; Kashyap, V.S. Lower extremity amputations: Factors associated with mortality or contralateral amputation. Vasc. Endovasc. Surg. 2013, 47, 608–613. [Google Scholar] [CrossRef]
- Thorud, J.C.; Plemmons, B.; Buckley, C.J.; Shibuya, N.; Jupiter, D.C. Mortality After Nontraumatic Major Amputation Among Patients with Diabetes and Peripheral Vascular Disease: A Systematic Review. J. Foot Ankle Surg. 2016, 55, 591–599. [Google Scholar] [CrossRef] [PubMed]
- Available online: https://pubmed.ncbi.nlm.nih.gov/?term=major+amputation&filter=years.2012-2024 (accessed on 10 November 2024).
- Long, C.A.; Mulder, H.; Fowkes, F.G.R.; Baumgartner, I.; Berger, J.S.; Katona, B.G.; Mahaffey, K.W.; Norgren, L.; Blomster, J.I.; Rockhold, F.W.; et al. Incidence and Factors Associated with Major Amputation in Patients with Peripheral Artery Disease: Insights from the EUCLID Trial. Circ. Cardiovasc. Qual. Outcomes 2020, 13, 395–403. [Google Scholar] [CrossRef]
- Abola, M.T.B.; Bhatt, D.L.; Duval, S.; Cacoub, P.P.; Baumgartner, I.; Keo, H.; Creager, M.A.; Brennan, D.M.; Steg, P.G.; Hirsch, A.T. Fate of individuals with ischemic amputations in the REACH Registry: Three-year cardiovascular and limb-related outcomes. Atherosclerosis 2012, 221, 527–535. [Google Scholar] [CrossRef]
- Courtin, E.; Knapp, M. Social isolation, loneliness and health in old age: A scoping review. Health Soc. Care Community 2017, 25, 799–812. [Google Scholar] [CrossRef]
- Friedmann, E.; Thomas, S.A.; Liu, F.; Morton, P.G.; Chapa, D.; Gottlieb, S.S. Relationship of depression, anxiety, and social isolation to chronic heart failure outpatient mortality. Am. Heart J. 2006, 152, e1–e940. [Google Scholar] [CrossRef]
- Cen, C.W.; Loehr, L.; Lin, F.C.; Hammond, W.P.; Foraker, R.E.; Rose, K.; Mosley, T.; Corbie-Smith, G. Social isolation, vital exhaustion, and incident heart failure: Findings from the Atherosclerosis Risk in Communities Study. Eur. J. Heart Fail. 2012, 14, 748–753. [Google Scholar] [CrossRef]
- Brummett, B.H.; Barefoot, J.C.; Siegler, I.C.; Clapp-Channing, N.E.; Lytle, B.L.; Bosworth, H.B.; Williams, R.B.; Mark, D.B. Characteristics of socially isolated patients with coronary artery disease who are at elevated risk for mortality. Psychosom. Med. 2001, 63, 267–272. [Google Scholar] [CrossRef] [PubMed]
- Kamiya, Y.; Whelan, B.; Timonen, V.; Kenny, R.A. The differential impact of subjective and objective aspects of social engagement on cardiovascular risk factors. BMC Geriatr. 2010, 10, 81. [Google Scholar] [CrossRef] [PubMed]
- Cacioppo, J.T.; Hawkley, L.C.; Crawford, L.E.; Ernst, J.M.; Burleson, M.H.; Kowalewski, R.B.; Malarkey, W.B.; Van Cauter, E.; Berntson, G.G. Loneliness and health: Potential mechanisms. Psychosom. Med. 2002, 64, 407–417. [Google Scholar] [CrossRef] [PubMed]
- Forrester, N.; Donzo, M.W.; Hu, C.; Mize, B.M.; Hui, K.H.; Duwayri, Y.; Brewster, L.; Alabi, O. Prosthetic fitting and mortality after major lower extremity amputation. J. Vasc. Surg. 2024, 80, 529–536. [Google Scholar] [CrossRef] [PubMed]
- Clegg, D.J.; Tasman, J.G.; Whiteaker, E.N.; Mazonas, T.W.; Salomon, B.J.; Dupuy, S.D.; Goldman, M.H.; Roberson, P.N.E. Ambulatory Status before Diabetic Foot Ulcer Development as a Predictor of Amputation and 1-Year Outcomes: A Retrospective Analysis. Plast. Reconstr. Surg. Glob. Open 2023, 11, E5383. [Google Scholar] [CrossRef]
- Dillingham, T.R.; Pezzin, L.E. Rehabilitation setting and associated mortality and medical stability among persons with amputations. Arch. Phys. Med. Rehabil. 2008, 89, 1038–1045. [Google Scholar] [CrossRef] [PubMed]
- Davie-Smith, F.; Coulter, E.; Kennon, B.; Wyke, S.; Paul, L. Factors influencing quality of life following lower limb amputation for peripheral arterial occlusive disease: A systematic review of the literature. Prosthet. Orthot. Int. 2017, 41, 537–547. [Google Scholar] [CrossRef] [PubMed]
- Fitzpatrick, M.C. The psychologic assessment and psychosocial recovery of the patient with an amputation. Clin. Orthop. Relat. Res. 1999, 361, 98–107. [Google Scholar] [CrossRef]
- Suckow, B.D.; Goodney, P.P.; Nolan, B.W.; Veeraswamy, R.K.; Gallagher, P.; Cronenwett, J.L.; Kraiss, L.W. Domains that Determine Quality of Life in Vascular Amputees. Ann. Vasc. Surg. 2015, 29, 722–730. [Google Scholar] [CrossRef]
- Oresanya, L.; Zhao, S.; Gan, S.; Fries, B.E.; Goodney, P.P.; Covinsky, K.E.; Conte, M.S.; Finlayson, E. Functional outcomes after lower extremity revascularization in nursing home residents: A national cohort study. JAMA Intern. Med. 2015, 175, 951–957. [Google Scholar] [CrossRef]
- McGinigle, K.L.; O’Banion, L.A.; Settembrini, A.M.; Vavra, A.K.; Garg, J.; Ayyash, K.; Arya, S.; Thomas, M.M.; Dell, K.E.; Swiderski, I.J.; et al. A framework for perioperative care in lower extremity major limb amputation: A consensus statement by the Enhanced Recovery After Surgery (ERAS) Society and Society for Vascular Surgery. JVS-Vasc. Insights 2024, 2, 100156. [Google Scholar] [CrossRef]
- Thorud, J.C.; Seidel, J.L. A Closer Look at Mortality After Lower Extremity Amputation. Pod. Today 2018, 31, 12–16. [Google Scholar]
- Hsu, M.J.; Nielsen, D.H.; Lin-Chan, S.J.; Shurr, D. The effects of prosthetic foot design on physiologic measurements, self-selected walking velocity, and physical activity in people with transtibial amputation. Arch. Phys. Med. Rehabil. 2006, 87, 123–129. [Google Scholar] [CrossRef]
- Genin, J.J.; Bastien, G.J.; Franck, B.; Detrembleur, C.; Willems, P.A. Effect of speed on the energy cost of walking in unilateral traumatic lower limb amputees. Eur. J. Appl. Physiol. 2008, 103, 655–663. [Google Scholar] [CrossRef] [PubMed]
- Serizawa, F.; Sasaki, S.; Fujishima, S.; Akamatsu, D.; Goto, H.; Amada, N. Mortality rates and walking ability transition after lower limb major amputation in hemodialysis patients. J. Vasc. Surg. 2016, 64, 1018–1025. [Google Scholar] [CrossRef]
- Kurdibaylo, S.F. Cardiorespiratory status and movement capabilities in adults with limb amputation. J. Rehabil. Res. Dev. 1994, 31, 222. [Google Scholar]
- Beeson, S.A.; Neubauer, D.; Calvo, R.; Sise, M.; Martin, M.; Kauvar, D.S.; Reid, C.M. Analysis of 5-year Mortality following Lower Extremity Amputation due to Vascular Disease. Plast. Reconstr. Surg. Glob. Open 2023, 11, E4727. [Google Scholar] [CrossRef]
- Yammine, K.; Hayek, F.; Assi, C. A meta-analysis of mortality after minor amputation among patients with diabetes and/or peripheral vascular disease. J. Vasc. Surg. 2020, 72, 2197–2207. [Google Scholar] [CrossRef] [PubMed]
- Jupiter, D.C.; Thorud, J.C.; Buckley, C.J.; Shibuya, N. The impact of foot ulceration and amputation on mortality in diabetic patients. I: From ulceration to death, a systematic review. Int. Wound J. 2016, 13, 892–903. [Google Scholar] [CrossRef] [PubMed]
- Melillo, E.; Micheletti, L.; Nuti, M.; Dell’Omo, G.; Berchiolli, R.N.; Adami, D.; Farina, A.; Panigada, G.; Meini, S. Long-term clinical outcomes in critical limb ischemia—A retrospective study of 181 patients. Eur. Rev. Med. Pharmacol. Sci. 2016, 20, 502–508. [Google Scholar] [PubMed]
- Ziegler-Graham, K.; MacKenzie, E.J.; Ephraim, P.L.; Travison, T.G.; Brookmeyer, R. Estimating the Prevalence of Limb Loss in the United States: 2005 to 2050. Arch. Phys. Med. Rehabil. 2008, 89, 422–429. [Google Scholar] [CrossRef]
- Creager, M.A.; Matsushita, K.; Arya, S.; Beckman, J.A.; Duval, S.; Goodney, P.P.; Gutierrez, J.A.T.; Kaufman, J.A.; Joynt Maddox, K.E.; Pollak, A.W.; et al. Reducing Nontraumatic Lower-Extremity Amputations by 20% by 2030: Time to Get to Our Feet: A Policy Statement from the American Heart Association. Circulation 2021, 143, E875–E891. [Google Scholar] [CrossRef]
Parameter | Non-Deceased Patients (n = 43) n (%) | Deceased Patients (n = 203) n (%) | Total (n = 246) n (%) |
---|---|---|---|
Age | 65 (57–70) | 74 (67–80) | 72 (65–79) |
Body Mass Index (BMI) | 26.2 (22.5–29.3) | 24.5 (22.2–27.7) | 24.7 (22.2–27.7) |
Male: Female | 30 (69.7): 13 (30.3) | 131 (64.5): 72 (35.5) | 161 (65.4): 85 (34.6) |
Arterial hypertension | 27 (62.8) | 177 (87.2) | 204 (82.9) |
Coronary artery disease Previous myocardial infarction | 15 (34.9) 8 (18.6) | 86 (42.4) 36 (17.7) | 101 (41.1) 44 (17.9) |
Diabetes mellitus | 21 (48.8) | 128 (63.1) | 149 (60.6) |
History of stroke | 7 (16.3) | 40 (19.7) | 47 (19.1) |
Hyperlipidemia | 20 (46.5) | 74 (36.5) | 94 (38.2) |
Pulmonary comorbidities | 13 (30.2) | 64 (31.5) | 77 (31.3) |
Chronic kidney disease | 19 (44.2%) | 109 (53.7%) | 128 (52.0) |
Previous ipsilateral revascularization | 16 (37.2%) | 83 (40.9%) | 99 (40.2%) |
Smoking Current History of smoking Non-smokers Missing: 35 (14.2%) | 27 (62.8) 4 (9.3) 8 (18.6) | 79 (38.9) 15 (7.4) 78 (38.4) | 106 (43.1) 19 (7.7) 86 (34.9) |
ASA Score 2 3 4 Missing: 16 (6.5%) | 3 (6.9) 33 (76.7) 4 (9.3) | 9 (4.4) 122 (60.1) 59 (29.1) | 12 (4.9) 155 (63.0) 63 (25.6) |
Level of amputation Transtibial Transfemoral | 33 (76.7) 10 (23.3) | 141 (69.5) 62 (30.5) | 174 (70.7) 72 (29.3) |
Parameter | Median Difference Observed and Estimated Life Expectancy (in Years) | Median Difference Observed and Estimated Life Expectancy (in Percent) |
---|---|---|
Sex | ||
Male | −11.2 | −90.5% |
Female | −8.7 | −84.6% |
ASA Score | ||
2 | −8.9 | −83.9% |
3 | −10.2 | −84.9% |
4 | −7.1 | −96.4% |
Smoking history | ||
Never | −8.5 | −87.5% |
Ex-smoker | −12.6 | −87.7% |
Current smoker | −12.9 | −90.4% |
Coronary artery disease | ||
Yes | −11.0 | −91.3% |
No | −9.7 | −88.3% |
Diabetes mellitus | ||
Yes | −10.5 | −84.4% |
No | −9.1 | −93.4% |
Household size | ||
Multi-person household | −9.9 | −81.5% |
Single living | −12.1 | −91.6% |
Assisted single living | −12.0 | −90.8% |
Nursing home | −5.4 | −92.4% |
Fontaine stage | ||
III | −8.9 | −94.4% |
IV | −10.0 | −87.2% |
Level of amputation | ||
Transtibial | −10.6 | −84.9% |
Transfemoral | −8.9 | −94.3% |
Mobility after discharge | ||
Prosthetic fitting | −11.4 | −74.7% |
Wheelchair | −10.7 | −79.8% |
Confined to bed | −5.7 | −85.9% |
Variable | Regression Coefficients from Multiple Linear Regression Model | R2 | Adjusted R2 | ||
---|---|---|---|---|---|
Estimate | 95% CI | p-Value | |||
Baseline | 4.03 | 1.68, 6.38 | <0.001 | ||
Life Expectancy | −0.96 | −0.941, −0.900 | <0.001 | ||
Living in a multi-person household | 1.19 | 0.52, 1.85 | <0.001 | ||
ASA Score | −0.86 | −1.49, −0.23 | 0.007 | 0.867 | 0.865 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Leinweber, M.E.; Greistorfer, E.; Rettig, J.; Taher, F.; Kliewer, M.; Assadian, A.; Hofmann, A.G. Quantification of the Survival Disadvantage Associated with Major Amputation in Patients with Peripheral Arterial Disease. J. Clin. Med. 2025, 14, 104. https://doi.org/10.3390/jcm14010104
Leinweber ME, Greistorfer E, Rettig J, Taher F, Kliewer M, Assadian A, Hofmann AG. Quantification of the Survival Disadvantage Associated with Major Amputation in Patients with Peripheral Arterial Disease. Journal of Clinical Medicine. 2025; 14(1):104. https://doi.org/10.3390/jcm14010104
Chicago/Turabian StyleLeinweber, Maria Elisabeth, Emanuel Greistorfer, Julia Rettig, Fadi Taher, Miriam Kliewer, Afshin Assadian, and Amun Georg Hofmann. 2025. "Quantification of the Survival Disadvantage Associated with Major Amputation in Patients with Peripheral Arterial Disease" Journal of Clinical Medicine 14, no. 1: 104. https://doi.org/10.3390/jcm14010104
APA StyleLeinweber, M. E., Greistorfer, E., Rettig, J., Taher, F., Kliewer, M., Assadian, A., & Hofmann, A. G. (2025). Quantification of the Survival Disadvantage Associated with Major Amputation in Patients with Peripheral Arterial Disease. Journal of Clinical Medicine, 14(1), 104. https://doi.org/10.3390/jcm14010104