Time-Dependent Impact of Diabetes on Mortality in Patients After Major Lower Extremity Amputation Survival in a population-based 5-year cohort in Germany

OBJECTIVE—To estimate the impact of diabetes on mortality in patients after first major lower extremity amputation (LEA). RESEARCH DESIGN AND METHODS—Using claims data of a nationwide statutory health insurance, we assessed all deaths in a cohort of all 444 patients with a first major LEA since 2005 (71.8 % male; mean age 69.1 years; 58.3 % diabetic; 43 % with amputation above the knee) up to 2009. Using Cox regression, we estimated the time-dependent hazard ratios to compare patients with and without diabetes. RESULTS—The cumulative 5-year mortality was 68 % in diabetic and 59 % in nondiabetic individuals. In the first course, mortality was lower in diabetic compared with nondiabetic patients. Later, the diabetes risk increased yielding crossed survival curves after 2 to 3 years (time dependency of diabetes; P = 0.003). Age- and sex-adjusted hazard ratios for diabetes wer