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eComment: Survival and lower limb amputees

Department for Cardiovascular Surgery, University Hospital Sestre Milosrdnice, Zagreb, Croatia

Mobility one year after unilateral lower limb amputation: a modern, UK institutional report

I read with interest the article by Basu et al. [1].

The authors stated that there was no significant difference in mobility outcome following below-knee amputation (BKA) or above-knee amputation (AKA) at one year, with mortality rates at 30 days and one year of 10% and 17%, respectively.

Previous studies have indicated a median 50% survival of 3–4 years with no significant differences between survival in men and women [2, 3]. These previous studies also indicated that survival rates were better in below-knee amputees, and that the vascular non-diabetic amputees survived longer than the diabetic dysvascular amputees.

For a more meticulous analysis of the topic, at this point, it could be useful to describe the results of our study which were undertaken to assess the 5-year and 10-year survival rates of major dysvascular lower limb amputees attending a sub-regional Disablement Services Centre (DCS) specialized in amputees' rehabilitation after operations performed at our vascular department.

In our study, the overall median survival from date of assessment was four years. Our study indicated 5-year and 10-year survival rates of respectively 63% and 55% for above-knee amputees and 37% and 22% for below-knee amputees. Unlike the other previously published studies, in our group patients with dysvascular below-knee amputations did worse than patients with above-knee amputations. Apart from delayed healing of stumps with resultant increase in morbidity in above-knee amputees, we were unable to delineate any specific reason for this particular finding. The improved survival rates in our study of median survival by 6–12 months as compared to the earlier published studies [2, 3], along with improved (46%) 10-year survival, are likely due to progress in the treatment of dysvascularity and diabetes in the last two decades. Moreover, in our study, patients with diabetes, either on its own or in combination with peripheral vascular disease, did worse than the non-diabetic cohort.

We concluded that early intervention by vascular teams, good glycemic control by diabetic teams, and comprehensive amputee rehabilitation management of dysvascular lower limb amputees have led to tangible survival improvement in the last decade. Hence, all efforts need to be made by both the amputee rehabilitation team and the community team to try to provide early coordinated care for these patients, to improve their quality of life and help them lead a less dependent lifestyle in the community setting.

I hope that our additional results will reinforce and clarify the conclusions suggested by the authors.

	References

Top References

 

1. Basu NN, Fassiadis N, McIrvine A. Mobility one year after unilateral lower limb amputation: a modern UK institutional report. Interact CardioVasc Thorac Surg 2008;7:1024–1027.[Abstract/Free Full Text]
2. Stewart CP, Jain AS, Ogston SA. Lower limb amputee survival. Prosthet Orthot Int 1992;16:11–18.[Medline]
3. Pohjolainen T, Alaranta H. Ten-year survival of Finnish lower limb amputees. Prosthet Orthot Int 1998;22:10–16.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Narcis Hudorovic Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hudorovic, N. Search for Related Content PubMed PubMed Citation Articles by Hudorovic, N. Related Collections Related Article