Postoperative outcomes of major lower extremity amputations in patients with diabetes and peripheral artery disease: analysis using the Diagnosis Procedure Combination database in Japan

• Dysvascular lower extremity amputations are most commonly associated with diabetes mellitus (DM) and peripheral artery disease (PAD).
• Synergistic effect of DM and PAD on postoperative outcomes has not been clarified.
• We investigated postoperative 30-day outcomes using Japanese inpatient database.
• Postoperative mortality did not differ between patients with DM, PAD, and both.
• Patients with both DM and PAD were more likely to have postoperative cardiac events.

BackgroundThe purpose of the present study was to investigate 30-day postoperative outcomes after lower extremity amputation in patients with diabetes mellitus (DM) alone, peripheral artery disease (PAD) alone, or both.MethodsEight thousand five hundred sixty-five patients with DM alone (n = 2,700), PAD alone (n = 2,919), and both (n = 2,946) who had above-knee amputation or below-knee amputation during 2007 to 2012 from the Japanese Diagnosis Procedure Combination inpatient database were retrospectively analyzed.ResultsOverall 30-day mortality was 6.4% (5.1%, 8.5%, and 5.6% in DM alone, PAD alone and both group, respectively). Multivariable regression analysis showed no significant differences in 30-day mortality or overall postoperative complication rates among the 3 groups. Patients with both PAD and DM had a significantly higher proportion of cardiac events than those with DM alone (6.9% vs 3.0%; odds ratio = 2.27; 95% confidence interval = 1.73 to 2.98).ConclusionsPatients with both DM and PAD were more likely to have postoperative cardiac events.