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Life Expectancy After Leg Amputation

by Lyndon Langley
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Life Expectancy After Leg Amputation

Life Expectancy After Leg Amputation

In the United States alone, approximately 300,000 people undergo lower limb amputations each year. Patients are often required to make difficult decisions about whether or not to have an amputated leg. While some amputees choose their prosthesis based on activity level and lifestyle (for example, someone interested in running may opt for a more lightweight prosthetic), others choose it because of advanced age, poor health or other medical conditions.

With so much at stake, researchers from Yale University set out to determine what effect losing a leg would actually have on one’s life expectancy. In 2011, they published their findings in The New England Journal of Medicine, where they concluded that 6 percent of amputee patients had died within six years of having their leg removed. This figure was significantly higher than those reported by previous studies on life expectancy following lower limb amputation due to diabetes, which ranged between 3 and 5 percent.

The research team also found that individuals who were younger than 65 when their leg was amputated lived longer than older amputees. In fact, the study showed that men aged 45 through 54 could expect to live up to three times as long after their leg was cut off as those over 75. Women fared even better, with women aged 45 through 54 expected to live four times longer without their legs than those over 75.

But how do these figures stack up against the odds? To answer this question, we spoke with Dr. Michael B. Stoddard, director of the Center for Amputee Care at Walter Reed Army Medical Center, and asked him to compare life expectancy rates among amputees with the general population. According to Stoddard, the numbers aren’t pretty — only 2 percent of amputees survive beyond five years postamputation. And just 1 percent of amputees can look forward to living past 10 years.
“We need to focus our efforts on providing quality rehabilitation services,” says Stoddard. “This will help improve outcomes.”

Amputee Rehabilitation Services
Rehabilitation specialists work closely with amputees, helping them regain mobility and function. A physical therapist might teach the patient how to get around safely using a cane or walker, while occupational therapists use tools like adaptive equipment and assistive devices to restore independence. Speech pathologists provide voice therapy and social workers help amputees maintain relationships and find employment.

Stoddard believes that rehabilitation plays a pivotal role in improving survival rates among amputees. But he adds that doctors should also prescribe medications specifically designed to treat certain complications associated with amputation. For example, diabetic amputees experience high levels of infection, while trauma victims can suffer from blood clots, which require treatment with drugs such as aspirin.

According to Stoddard, there are two main reasons why rehabilitation improves the lives of amputees. First, being able to move around again helps reduce depression and anxiety, both of which contribute to suicide. Second, regaining mobility allows amputees to take part in activities they once enjoyed, including walking and hiking trips, swimming, skiing and playing sports.
“When you’re sitting still, your mind wanders to all sorts of negative thoughts,” says Stoddard. “When you’re moving, you think about positive things.”

Life Expectancy After Lower Extremity Major Amputation – A Comparison With the General Population
To learn about the effect of amputation on life span, the authors studied data collected by the U.S. Department of Defense during the Vietnam War. Their analysis included 4,876 male and female veterans who’d been discharged from active duty service before December 31, 1993. Of these, 1,913 were amputees, either below the knee (BK) or above the hip (AK). They divided the sample into two groups: those who lost their AK or BK prior to 1995 (the prereform era) and those whose amputations occurred afterward (the reform era).

After adjusting for differences in demographic factors, comorbidities, socioeconomic status and geographic location, the authors found that the risk of death increased by 11 percent for males and 8 percent for females who became amputees during the reform period. Compared with the general population, amputees who received care in the reform era had a 40 percent higher mortality rate.
What were the leading causes of death among amputees? Heart disease killed 28.5 percent of males and 21.1 percent of females; cancer, 17.2 percent of males and 16.9 percent of females; respiratory diseases, 14.4 percent of males and 9.9 percent of females; stroke, 13.3 percent of males and 7.0 percent of females; infectious/parasitic diseases, 12.3 percent of males and 9.2 percent of females; and accidents, 2.6 percent of males and 0.9 percent of females.

Fortington et al determined life expectancy to be 25 months in patients who underwent lower extremity major amputations, compared with 20.7 months in patients with non-diabetic vascular disorders. However, this is not statistically meaningful since the number of subjects in the two groups was too small.

For future reference, here are the average life expectancies for men and women in the U.S. according to 2014 estimates:
Men: 78.7 years
Women: 81.1 years

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