Impact of diabetes on long-term mortality following major lower limb amputation: A population-based cohort study in Wales

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice Pub Date : 2025-04-09 DOI:10.1016/j.diabres.2025.112156

Jennifer Hayes , James M Rafferty , Wai-Yee Cheung , Ashley Akbari , Rebecca L Thomas , Steve Bain , Claire Topliss , Jeffery W Stephens

{"title":"Impact of diabetes on long-term mortality following major lower limb amputation: A population-based cohort study in Wales","authors":"Jennifer Hayes , James M Rafferty , Wai-Yee Cheung , Ashley Akbari , Rebecca L Thomas , Steve Bain , Claire Topliss , Jeffery W Stephens","doi":"10.1016/j.diabres.2025.112156","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Major lower limb amputation is associated with high morbidity and mortality, particularly among patients with diabetes. Previous studies suggest variable mortality rates, but none have investigated the impact of diabetes in Wales.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":11249,"journal":{"name":"Diabetes research and clinical practice","volume":"223 ","pages":"Article 112156"},"PeriodicalIF":6.1000,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Diabetes research and clinical practice","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0168822725001706","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Major lower limb amputation is associated with high morbidity and mortality, particularly among patients with diabetes. Previous studies suggest variable mortality rates, but none have investigated the impact of diabetes in Wales.

Methods

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.

Conclusion

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.

查看原文本刊更多论文

糖尿病对主要下肢截肢后长期死亡率的影响：威尔士一项基于人群的队列研究

背景：下肢截肢与高发病率和死亡率相关，尤其是糖尿病患者。以前的研究表明，威尔士的死亡率各不相同，但没有人调查过糖尿病对威尔士的影响。方法采用安全匿名信息关联数据库中的匿名数据进行人群队列研究。2006年至2013年威尔士≥18岁的所有重大截肢事件的生存率通过5年随访进行评估。Kaplan-Meier生存曲线和Cox回归模型，按截肢水平分层，在校正混杂因素的同时，检验糖尿病对死亡率的时间依赖性影响。结果大截肢2542例，糖尿病患者48.4%。30天死亡率为9.2%，5年内死亡率为61.9%。糖尿病患者的5年死亡率（67.0%）高于非糖尿病患者（57.1%）。糖尿病与长期死亡风险增加相关(危险比1.62,p <；0.001)，但在截肢后的前30天内死亡风险降低。周围血管疾病史和膝上截肢是死亡率的重要预测因素。结论时间分层分析显示，糖尿病患者截肢术后短期死亡率较低，但长期死亡率较高。需要进一步的研究来探索旨在提高生存率的干预措施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Diabetes research and clinical practice 医学-内分泌学与代谢

CiteScore

10.30

自引率

3.90%

发文量

862

审稿时长

32 days

期刊介绍： Diabetes Research and Clinical Practice is an international journal for health-care providers and clinically oriented researchers that publishes high-quality original research articles and expert reviews in diabetes and related areas. The role of the journal is to provide a venue for dissemination of knowledge and discussion of topics related to diabetes clinical research and patient care. Topics of focus include translational science, genetics, immunology, nutrition, psychosocial research, epidemiology, prevention, socio-economic research, complications, new treatments, technologies and therapy.