Mortality after major amputation in elderly patients with critical limb ischemia

Sanne Klaphake,1,2 Kevin de Leur,1 Paul GH Mulder,1,3 Gwan H Ho,1 Hans G de Groot,1 Eelco J Veen,1 Hence JM Verhagen,2 Lijckle van der Laan1 1Department of Surgery, Amphia Hospital, Breda, 2Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, 3Amphia Academy, Amphia Hospita...

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Autores principales: Klaphake S, de Leur K, Mulder PGH, Ho GH, de Groot HG, Veen EJ, Verhagen HJM, van der Laan L
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Publicado: Dove Medical Press 2017
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spelling oai:doaj.org-article:eb96b548133949e4ada64f130f8e396a2021-12-02T02:38:38ZMortality after major amputation in elderly patients with critical limb ischemia1178-1998https://doaj.org/article/eb96b548133949e4ada64f130f8e396a2017-11-01T00:00:00Zhttps://www.dovepress.com/mortality-after-major-amputation-in-elderly-patients-with-critical-lim-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Sanne Klaphake,1,2 Kevin de Leur,1 Paul GH Mulder,1,3 Gwan H Ho,1 Hans G de Groot,1 Eelco J Veen,1 Hence JM Verhagen,2 Lijckle van der Laan1 1Department of Surgery, Amphia Hospital, Breda, 2Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, 3Amphia Academy, Amphia Hospital, Breda, the Netherlands Background: Owing to the aging population, the number of elderly patients with critical limb ischemia (CLI) has increased. The consequence of amputation is immense. However, at the moment, information about the mortality after amputation in the elderly vascular patients is unknown. For this reason, this study evaluated mortality rates and patient-related factors associated with mortality after a major amputation in elderly patients with CLI.Methods: From 2006 to 2013, we included patients aged >70 years who were treated for chronic CLI by primary or secondary major amputation within or after 3 months of initial therapy (revascularization or conservative management). Outcome measurements were mortality after major amputation and factors associated with mortality (age, comorbidity and timing of amputation).Results: In total, 168/651 patients (178 legs; 26%) underwent a major amputation. Patients were stratified by age: 70–80 years (n=86) and >80 years (n=82). Overall mortality after major amputation was 44%, 66% and 85% after 1, 3 and 5 years, respectively. The 6-month and 1-year mortality in patients aged 80 years or older was, respectively, 59% or 63% after a secondary amputation <3 months versus 34% and 44% after a secondary amputation >3 months. Per year of age, the mortality rate increased by 4% (P=0.005). No significant difference in mortality after major amputation was found in the presence of comorbidity or according to Rutherford classification.Conclusion: Despite developments in the treatment of CLI by revascularization, amputation rates remain high and are associated with tremendous mortality rates. Secondary amputation after a failed attempt of revascularization causes a higher mortality. Further research concerning timing of amputation and patient-related outcome is needed to evaluate if selected patients might benefit from primary amputation. Keywords: peripheral arterial disease, aged, limb ischemia, primary amputation, octogenarians, patient selectionKlaphake Sde Leur KMulder PGHHo GHde Groot HGVeen EJVerhagen HJMvan der Laan LDove Medical Pressarticlemajor amputationmortalityelderlycritical limb ischemiaGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 12, Pp 1985-1992 (2017)
institution DOAJ
collection DOAJ
language EN
topic major amputation
mortality
elderly
critical limb ischemia
Geriatrics
RC952-954.6
spellingShingle major amputation
mortality
elderly
critical limb ischemia
Geriatrics
RC952-954.6
Klaphake S
de Leur K
Mulder PGH
Ho GH
de Groot HG
Veen EJ
Verhagen HJM
van der Laan L
Mortality after major amputation in elderly patients with critical limb ischemia
description Sanne Klaphake,1,2 Kevin de Leur,1 Paul GH Mulder,1,3 Gwan H Ho,1 Hans G de Groot,1 Eelco J Veen,1 Hence JM Verhagen,2 Lijckle van der Laan1 1Department of Surgery, Amphia Hospital, Breda, 2Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, 3Amphia Academy, Amphia Hospital, Breda, the Netherlands Background: Owing to the aging population, the number of elderly patients with critical limb ischemia (CLI) has increased. The consequence of amputation is immense. However, at the moment, information about the mortality after amputation in the elderly vascular patients is unknown. For this reason, this study evaluated mortality rates and patient-related factors associated with mortality after a major amputation in elderly patients with CLI.Methods: From 2006 to 2013, we included patients aged >70 years who were treated for chronic CLI by primary or secondary major amputation within or after 3 months of initial therapy (revascularization or conservative management). Outcome measurements were mortality after major amputation and factors associated with mortality (age, comorbidity and timing of amputation).Results: In total, 168/651 patients (178 legs; 26%) underwent a major amputation. Patients were stratified by age: 70–80 years (n=86) and >80 years (n=82). Overall mortality after major amputation was 44%, 66% and 85% after 1, 3 and 5 years, respectively. The 6-month and 1-year mortality in patients aged 80 years or older was, respectively, 59% or 63% after a secondary amputation <3 months versus 34% and 44% after a secondary amputation >3 months. Per year of age, the mortality rate increased by 4% (P=0.005). No significant difference in mortality after major amputation was found in the presence of comorbidity or according to Rutherford classification.Conclusion: Despite developments in the treatment of CLI by revascularization, amputation rates remain high and are associated with tremendous mortality rates. Secondary amputation after a failed attempt of revascularization causes a higher mortality. Further research concerning timing of amputation and patient-related outcome is needed to evaluate if selected patients might benefit from primary amputation. Keywords: peripheral arterial disease, aged, limb ischemia, primary amputation, octogenarians, patient selection
format article
author Klaphake S
de Leur K
Mulder PGH
Ho GH
de Groot HG
Veen EJ
Verhagen HJM
van der Laan L
author_facet Klaphake S
de Leur K
Mulder PGH
Ho GH
de Groot HG
Veen EJ
Verhagen HJM
van der Laan L
author_sort Klaphake S
title Mortality after major amputation in elderly patients with critical limb ischemia
title_short Mortality after major amputation in elderly patients with critical limb ischemia
title_full Mortality after major amputation in elderly patients with critical limb ischemia
title_fullStr Mortality after major amputation in elderly patients with critical limb ischemia
title_full_unstemmed Mortality after major amputation in elderly patients with critical limb ischemia
title_sort mortality after major amputation in elderly patients with critical limb ischemia
publisher Dove Medical Press
publishDate 2017
url https://doaj.org/article/eb96b548133949e4ada64f130f8e396a
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