Jennifer Hayes , James M Rafferty , Wai-Yee Cheung , Ashley Akbari , Rebecca L Thomas , Steve Bain , Claire Topliss , Jeffery W Stephens
{"title":"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","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":"{\"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. 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Impact of diabetes on long-term mortality following major lower limb amputation: A population-based cohort study in Wales
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.
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.