Risk Factors for Premature Death in Diabetes Patients who Undergo Amputations below Ankle Level

Abstract

To identify risk factors for early death in diabetes patients who undergo amputations below the ankle. A retrospective study, where all hospital records of all diabetes patients who had undergone minimum one amputation below the ankle at the CWHC Bispebjerg Hospital, Denmark, in the period 1996-2013, were examined. The amputations were mainly trans-metatarsal amputations and partial amputations of toes. The participants were found via ICD10-codes. The included patients were followed from their first contact to the last registered contact. The statistical analysis in this article is performed on patients with a of minimum 5-year follow-up. The 5 year mortality was 42% for patients with type 2 diabetes, and 29% for patients with type 1 diabetes. For patients with type 2 diabetes, multivariable analysis showed that high age, peripheral arterial insufficiency and short time from first admission to amputation were independently statistically significantly associated with increased 5-years mortality. Use of statins was associated with decreased mortality. 35% died as a result of their diabetes, mostly due to cardiovascular causes. Short time from first admission to amputation is a risk factor for early death. Arterial insufficiency and high age is also associated with increased mortality, whereas use of statin is associated with decreased mortality, in patients with type 2 diabetes.