Is amputation in the elderly patient with critical limb ischemia acceptable in the long term?

Figures & data

Table 1 Patient characteristics

	Amputees n=49 (100%)
Sex (male)	31 (64)
Median Age (IQR)	82 (75;84)
Living situation
– Independent*	23 (47)
– Home care	17 (35)
– Nursing facility	6 (12)
– Missing	3 (6)
Civil status
– Single	8 (16)
– Married or living with partner*	22 (45)
– Divorced	2 (4)
– Widowed*	14 (29)
– Missing	3 (6)
Educational level
– Low	20 (41)
– Middle	20 (41)
– High	6 (12)
– Missing	3 (6)
Currently smoking	10 (20)
Cardiac comorbidity	41 (84)
Neurologic comorbidity	17 (35)
Pulmonary comorbidity	36 (74)
Renal impairment	29 (59)
Arthrosis	9 (18)
Diabetes mellitus	27 (55)
Hypertension	31 (63)
Rutherford classification*
– Rutherford-class 4	8 (16)
– Rutherford-class 5/6	41 (84)
ASA classification
– ASA 2	9 (19)
– ASA 3	35 (71)
– ASA 4	5 (10)
Initially selected therapy
– Endovascular revascularization	21 (43)
– Surgical revascularization	12 (24)
– Conservative therapy	11 (23)
– Primary amputation	5 (10)
Previous minor amputation	13 (27)
Type of amputation
– Above knee amputation	15 (31)
– Through knee amputation	4 (8)
– Below knee amputation	30 (61)

Notes: Data are presented as n (%), unless otherwise specified. *Significant difference between age groups (p< 0.05).

Abbreviations: n, number of patients; IQR, interquartile range; ASA, American Society of Anesthesiologists.

Table 2 Patient discharge

	Amputees n=49 (100%)
Discharge to
– Home	9 (18)
– Nursing facility	16 (33)
– Inpatient rehabilitation	18 (37)
– Decease before discharge	3 (6)
– Missing	3 (6)

Notes: Data are presented as n and (%).

Table 3 Time to conduction of the questionnaires

	n	Median time	IQR
Baseline	49
Half year	23	167	148–185
1 year	16	357	336.5–362.75
1.5–2 years	11	697	651–726

Note: Data presented as median.

Abbreviations: n, number of patients; IQR, interquartile range.

Table 4 Patient-reported outcomes for amputees (n=49)

	n	Mean	SD	p-value	95% CI
WHOQOL-BREF overall QoL
Baseline	49	3.18	0.85
Half year	23	3.47	0.59	0.342	−0.1796; 0.4947
1 year	16	3.63	0.56	0.121	−0.0843; 0.6814
1.5–2 years	11	3.55	0.42	0.198	−0.1439; 0.6368
WHOQOL-BREF physical health
Baseline	49	11.29	2.67
Half year	23	14.44	2.33	≤0.001	1.6123; 4.2901
1 year	16	14.46	2.34	≤0.001	1.6320; 4.1622
1.5–2 years	11	14.75	1.86	≤0.001	2.4949; 4.9603
WHOQOL-BREF Psychological health
Baseline	49	14.00	2.36
Half year	23	14.89	1.90	0.162	−0.2052; 1.1654
1 year	16	15.17	1.57	0.199	−0.3819; 1.7532
1.5–2 years	11	14.73	1.28	0.269	−0.3395; 1.1448
WHOQOL-BREF social relationships
Baseline	49	15.99	2.23
Half year	23	16.17	2.00	0.897	−0.7205; 0.8220
1 year	15	16.36	1.55	0.978	−0.9858; 0.9587
1.5–2 years	11	15.76	1.59	0.163	−1.7996; 0.3037
WHOQOL-BREF environment
Baseline	49	15.57	2.07
Half year	23	14.96	1.45	0.067	−1.3431; 0.0463
1 year	16	15.34	1.42	0.702	−0.8126; 0.5473
1.5–2 years	11	15.36	0.74	0.125	−1.0256; 0.1248
SF-physical
Baseline	48	29.73	9.36
Half year	23	34.98	6.54	0.015	0.9095; 7.8204
1 year	16	34.97	5.40	0.022	0.6319; 7.7767
1.5–2 years	11	35.72	4.77	≤0.001	3.0249; 9.1026
SF-mental
Baseline	48	38.64	11.37
Half year	23	43.21	6.97	0.063	−0.2088; 7.69,795
1 year	16	43.66	8.55	0.262	−2.4686; 8.7032
1.5–2 years	11	44.46	9.07	0.002	3.8787; 12.5862
CESD
Baseline	48	8.69	7.05
Half year	22	4.45	4.72	0.004	−5.9119; −1.2185
1 year	16	4.56	3.44	0.004	−6.6151; −1.3993
1.5–2 years	11	5.00	4.90	0.050	−6.3459; 0.0027

Notes: Data presented as mean.  A p-value<0 .05 is considered significant and is characterized by bold text.

Abbreviations: n, number of patients; SD, standard deviation; CI, confidence interval; WHOQOL-BREF, World Health Organization Quality Of Life -abbreviated version of the WHOQOL 100; CESD, Center for Epidemiologic Studies Depression.

Table 5 WHOQOL-BREF compared to normal values for elderly

	n	Value	Value of general elderly population^Citation27	Mean difference	p-value	95% CI
Item 1. How would you rate your quality of life?
Very poor (1) – poor (2) – neither poor nor good (3) – good (4) – very good (5)
Baseline	49	3.33	4.06	−0.733	<0.001	−1.01; −0.46
Half year	22	3.27		−0.787	<0.001	−1.10; −0.48
1 year	17	3.65		−0.413	0.027	−0.77; −0.05
1.5–2 years	11	3.45		−0.605	0.003	−0.96; −0.25
Item 3. To what extend do you feel that physical pain prevents you from doing what you need to do? Not at all (1) – a little (2) – a moderate amount (3) – very much (4) – an extreme amount (5)
Baseline	48	3.23	2.46	0.769	<0.001	0.47; 1.06
Half year	21	1.86		−0.603	0.022	−1.11; −0.10
1 year	16	1.56		−0.898	0.002	−1.41; −0.38
1.5–2 years	11	1.64		−0.824	0.024	−1.51; −0.13
Item 5. How much do you enjoy life? Not at all (1) – a little (2) – a moderate amount (3) – very much (4) – an extreme amount (5)
Baseline	49	3.10	3.31	−0.208	0.083	−0.44; 0.03
Half year	22	3.48		0.166	0.360	−0.20; 0.54
1 year	17	3.35		0.043	0.852	−0.44; 0.52
1.5–2 years	11	3.45		0.145	0.380	−0.21; 0.50
Item 10. Do you have enough energy for everyday life? Not at all (1) – a little (2) – moderately (3) – mostly (4) – completely (5)
Baseline	49	3.29	4.09	−0.804	<0.001	−1.10; −0.51
Half year	22	3.64		−0.454	<0.001	−0.67; −0.24
1 year	17	3.41		−0.678	<0.001	−1.00; −0.36
1.5–2 years	11	3.55		−0.545	0.052	−1.10; 0.01
Item 11. Are you able to accept you bodily appearance? Not at all (1) – a little (2) – moderately (3) – mostly (4) – completely (5)
Baseline	48	3.77	4.36	−0.589	<0.001	−0.89; −0.29
Half year	22	3.86		−0.496	0.007	−0.84; −0.15
1 year	17	3.88		−0.478	<0.001	−0.65; −0.31
1.5–2 years	11	3.73		−0.633	0.024	−1.16; −0.10
Item 16. How satisfied are you with your ability to perform daily living activities? Very dissatisfied (1) – dissatisfied (2) – neither satisfied nor dissatisfied (3) – satisfied (4) – very satisfied (5)
Baseline	49	2.88	3.81	−0.932	<0.001	−1.24; −0.63
Half year	22	3.18		−0.628	0.006	−1.05; −0.20
1 year	17	3.24		−0.575	0.018	−1.04; −0.11
1.5–2 years	11	3.55		−0.265	0.231	−0.73; 0.20
Item 18. How satisfied are you with yourself? Very dissatisfied (1) – dissatisfied (2) – neither satisfied nor dissatisfied (3) – satisfied (4) – very satisfied (5)
Baseline	49	3.57	3.97	−0.399	0.002	−0.65; −0.15
Half year	22	3.82		−0.152	0.240	−0.41; 0.11
1 year	17	3.82		−0.146	0.270	−0.42; 0.13
1.5–2 years	11	3.73		−0.243	0.116	−0.56; 0.07
Item 25. How well are you able to get around? Very poor (1) – poor (2) - neither poor nor good (3) – good (4) – very good (5)
Baseline	47	2.49	3.70	−1.211	<0.001	−1.56; −0.87
Half year	22	3.32		−0.382	0.058	−0.78; 0.01
1 year	17	3.53		−0.171	0.433	−0.62; 0.28
1.5–2 years	11	3.36		−0.366	0.255	−0.96; 0.28

Notes: Data presented as mean; The value of the general elderly population is based on reference 27. One sample t-tests were used to compare the mean QoL estimates to corresponding estimates in the general elderly population.  A p-value of <0.05 is considered significant and is characterized by bold text.

Abbreviations: n, number of patients; CI, confidence interval; QoL, quality of life; WHOQOL-BREF, World Health Organization Quality Of Life -abbreviated version of the WHOQOL 100.

de Vries J. Beyond health status: Construction and validation of the Dutch WHO Quality of Life assessment instrument [ Ph.D. thesis]. Tilburg: Tilburg University; 1996.

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