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.