gms | German Medical Science

15. Deutscher Kongress für Versorgungsforschung

Deutsches Netzwerk Versorgungsforschung e. V.

5. - 7. Oktober 2016, Berlin

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Amputations and mortality in patients with peripheral artery disease and diabetic foot syndrome

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  • Nasser Malyar - Universitätsklinikum Münster, Department für Kardiologie und Angiologie, Abteilung für Angiologie,, Münster, Deutschland
  • Eva Freisinger - Universitätsklinikum Münster, Abteilung für Angiologie, Department für Kardiologie und Angiologie, Münster, Deutschland
  • Matthias Meyborg - Universitätsklinikum Münster, Department für Kardiologie und Angiologie, Abteilung für Angiologie,, Münster, Deutschland
  • Florian Lüders - Universitätsklinikum Münster, Abteilung für Angiologie, Department für Kardiologie und Angiologie, Münster, Deutschland
  • Katrin Gebauer - Universitätsklinikum Münster, Department für Kardiologie und Angiologie, Abteilung für Angiologie,, Münster, Deutschland
  • Holger Reinecke - Universitätsklinikum Münster, Abteilung für Angiologie, Department für Kardiologie und Angiologie, Münster, Deutschland
  • Holger Lawall - Praxis für Herzkreislauferkrankungen und Akademie für Gefäßkrankheiten, Ettlingen, Ettlingen, Deutschland

15. Deutscher Kongress für Versorgungsforschung. Berlin, 05.-07.10.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocP032

doi: 10.3205/16dkvf133, urn:nbn:de:0183-16dkvf1339

Published: September 28, 2016

© 2016 Malyar et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Aims/hypothesis: The prevalence of diabetes mellitus (DM) and its associated complications such as peripheral artery disease (PAD) and diabetic foot syndrome (DFS) are increasing worldwide. We aimed to determine the contemporary acute and long-term outcome of patients with PAD and DFS in Germany.

Methods: Nationwide, anonymized administrative data of 40,335 patients hospitalized for PAD and/or DFS from the years 2009-2011 were analyzed and followed up until 2013. Patients were classified into 3 groups: DFS, PAD+DM and PAD without DM. In-hospital and long-term outcome (1,156 days, 95% CI 1.151–1.161) regarding major and minor amputation and mortality was assessed. Cumulative amputation-free survival and overall survival rates were calculated using Kaplan-Meier analysis.

Results: The proportion of DFS, PAD+DM and PAD was 17.3%, 21.5% and 61.2%, respectively. At index-hospitalization, DFS patients had the highest amputation (31.9% vs. 11.1% vs. 6.0%), yet the lowest revascularization rate (18.2% vs. 67.8% vs. 71.6%) compared to patients with PAD and PAD+DM (P<0.001). Cumulative four year survival (57.4%, 60.8% and 70.0%) and amputation-free-survival (45.4%, 74.4% and 86.5%) were lowest for DFS followed by PAD+DM and PAD (P<0.001, Figure 1 [Fig. 1]).

Conclusions and clinical implications: Patients with diabetes, particularly those with DFS, have persistent high rates of limb amputation and of mortality. These real-world-data unmask the gap between acceptable results derived from studies conducted at highly specialized centers and the de facto status in a real-world setting. The findings emphasize the need for further dedicated research to identify and target the underlying causes of the extraordinary poor outcome in this high risk population.