In general, those with diabetes with an LEA are two to three times more likely to die at any given time point than those with diabetes who have not had an LEA ( 5). In the U.K., up to 80% will die within 5 years of an LEA ( 8). Medicare population mortality within a year after an incident LEA was 23.1% in 2006, 21.8% in 2007, and 20.6% in 2008 ( 4). Previous reports have estimated that the 1-year post-LEA mortality rate in people with diabetes is between 10 and 50%, and the 5-year mortality rate post-LEA is between 30 and 80% ( 4, 13– 15). However, 30-day postoperative mortality can approach 10%, with most mortality associated with those receiving an LEA as an emergency procedure or with the presence of preoperative sepsis ( 11, 12).
The surgical procedure itself is associated with a risk of death that is based on the American Society of Anesthesiologist physical status classification system and is not dependent on risks inherent to the procedure. Many researchers have reported a large increase in the incidence of death among LEA patients. An LEA occurs because of a disease complication, usually a foot ulcer that is not healing (e.g., organ failure of the skin, failure of the biomechanics of the foot as a unit, nerve sensory loss, and/or impaired arterial vascular supply), but it also occurs at least in part as a consequence of a medical plan to amputate based on a decision between health care providers and patients ( 9, 10). LEA does not represent a traditional medical complication of diabetes like myocardial infarction (MI), renal failure, or retinopathy in which organ failure is directly associated with diabetes ( 2). In 2012, in the U.K., it was estimated that the National Health Service spent between £639 and 662 million on foot ulcers and LEA, which was approximately £1 in every £150 spent by the National Health Service ( 8). Medicare program accounted for $41 billion in cost, which is ∼1.6% of all Medicare health care spending ( 4– 7). In 2012, it was estimated that those with diabetes and lower-extremity wounds in the U.S. LEA in those with diabetes generally carries yearly costs between $30,000 and $60,000 and lifetime costs of half a million dollars ( 4). Medicare population, the incidence of diabetic foot ulcers is ∼6 per 100 individuals with diabetes per year and the incidence of LEA is 4 per 1,000 persons with diabetes per year ( 3). According to the World Health Organization, lower-extremity amputations (LEAs) are 10 times more common in people with diabetes than in persons who do not have diabetes. Nearly 2 million people living in the U.S. Worldwide, every 30 s, a limb is lost to diabetes ( 1, 2).
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