Diabetes Increases Long-Term Mortality Risk After Major Lower Limb Amputation: Study

A population-based cohort study was conducted using anonymised data from the Secure Anonymised Information Linkage Databank. Survival from all incident major amputations in persons ≥ 18 years from 2006 to 2013 in Wales was assessed over 5-year follow-up. Kaplan-Meier survival curves and Cox regression models, stratified by amputation level, were used to examine the time-dependent effect of diabetes on mortality while adjusting for confounding factors.

Results: 2542 individuals underwent major amputation, 48.4 % had diabetes. Mortality at 30 days was 9.2 % and 61.9 % within 5 years. Patients with diabetes had higher 5-year mortality (67.0 %) compared to those without diabetes (57.1 %). Diabetes was associated with an increased risk of long-term mortality (hazard ratio 1.62, p < 0.001), but a reduced risk of death in the first 30 days post-amputation. A history of peripheral vascular disease and above-knee amputation were strong predictors of mortality.

Time-stratified analysis demonstrates lower short-term but higher long-term mortality risk for persons with diabetes following major amputation. Further research is required to explore interventions aimed at improving survival.

Reference:

Jennifer Hayes, James M Rafferty, Wai-Yee Cheung, Ashley Akbari, Rebecca L Thomas, Steve Bain, Claire Topliss, Jeffery W Stephens. Impact of diabetes on long-term mortality following major lower limb amputation: A population-based cohort study in Wales, Diabetes Research and Clinical Practice, Volume 223, 2025, 112156, ISSN 0168-8227.https://doi.org/10.1016/j.diabres.2025.112156.