Pires Maria, Diniz João, Aguiar Ana, Estrela Marta, Cantista Pedro, Vaz Mário, Neves Francisco, Fialho Ana, Silva Catarina
Physical Medicine and Rehabilitation, Unidade Local de Saúde do Algarve, Faro, PRT.
Physical Medicine and Rehabilitation, Unidade Local de Saúde Tâmega e Sousa, Penafiel, PRT.
Cureus. 2025 Aug 28;17(8):e91199. doi: 10.7759/cureus.91199. eCollection 2025 Aug.
Introduction Despite being one of the earliest documented surgical procedures, lower extremity amputation (LEA) continues to be frequently performed in modern clinical practice. Currently, most LEAs are associated with diabetes mellitus (DM) and peripheral artery disease. Although long-term mortality after LEA remains high, recent evidence suggests that survival following major LEA may be improving. This trend is considered multifactorial, with advances in cardiovascular disease management being a major contributing factor. The aim of this retrospective study was to quantify the long-term mortality rate following LEA and to assess the relative contribution of comorbidities to overall mortality. Methods A single-center, observational, retrospective study was conducted at a central hospital in Portugal. Medical records of all patients who attended outpatient consultations in Physical Medicine and Rehabilitation - Amputees following LEA between January 2015 and June 2024 were analyzed. Results A total of 730 patients were included, with a mean age of 68 years; 72% were male. Nearly one-third of the patients had a history of smoking. During the follow-up period, 208 patients died, with a mean age at death of 71 years. The five- and 15-year mortality rates were 20% and 26%, respectively. The leading causes of amputation were vascular disease (64%) and trauma (19%). Amputations due to oncological disease were associated with the poorest survival outcomes, followed by those caused by vascular disease. With respect to amputation level, hip disarticulation was associated with the lowest long-term survival. Mortality rates were slightly higher for transfemoral amputations (31%) compared with transtibial amputations (28%). DM and hypertension were identified as risk factors for post-acute mortality. Conclusions This study confirms the high long-term mortality associated with LEA but also suggests that survival rates may be improving. Vascular disease remains the most common cause of LEA and the second leading contributor to poor survival outcomes. These findings highlight the importance of preventive strategies to reduce amputation rates and underscore the critical role of comprehensive, interdisciplinary care, including effective management of cardiovascular risk factors, in mitigating long-term mortality.
引言 尽管下肢截肢术（LEA）是最早有文献记载的外科手术之一，但在现代临床实践中仍经常进行。目前，大多数下肢截肢术与糖尿病（DM）和外周动脉疾病有关。尽管下肢截肢术后的长期死亡率仍然很高，但最近的证据表明，大截肢术后的生存率可能正在提高。这种趋势被认为是多因素的，心血管疾病管理的进展是一个主要促成因素。这项回顾性研究的目的是量化下肢截肢术后的长期死亡率，并评估合并症对总体死亡率的相对贡献。方法 在葡萄牙一家中心医院进行了一项单中心、观察性、回顾性研究。分析了2015年1月至2024年6月期间在物理医学与康复门诊就诊的所有下肢截肢术后患者的病历。结果 共纳入730例患者，平均年龄68岁；72%为男性。近三分之一的患者有吸烟史。在随访期间，208例患者死亡，平均死亡年龄为71岁。5年和15年死亡率分别为20%和26%。截肢的主要原因是血管疾病（64%）和创伤（19%）。因肿瘤疾病导致的截肢与最差的生存结果相关，其次是血管疾病导致的截肢。就截肢水平而言，髋关节离断术的长期生存率最低。经股骨截肢术（31%）的死亡率略高于经胫骨截肢术（28%）。糖尿病和高血压被确定为急性后死亡率的危险因素。结论 本研究证实了下肢截肢术相关的高长期死亡率，但也表明生存率可能正在提高。血管疾病仍然是下肢截肢术最常见的原因，也是导致不良生存结果的第二大因素。这些发现突出了预防策略以降低截肢率的重要性，并强调了全面、跨学科护理，包括有效管理心血管危险因素，在降低长期死亡率方面的关键作用。
