Mortality After Lower Extremity Amputation: A Portuguese Study

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.