Long-term mortality after lower extremity amputation: A retrospective study at a second-level government hospital in Cape Town, South Africa

  • Salah R. Husein
  • Megan Naidoo
  • Heather Bougard
  • Kathryn M. Chu
Keywords: surgery, amputation, postoperative mortality, health systems strengthening, South Africa


Background: Long-term mortality after lower extremity amputation (LEA) is not well reported in low- and middle-income countries. The primary aim of this study was to report 30-day and 1-year mortality rates after LEA in South Africa. The secondary objective was to report risk factors associated with death within 1 postoperative year.

Methods: This was a retrospective study of patients who underwent LEA at New Somerset Hospital, a second-level government facility in Cape Town, South Africa, from 1 October 2015 through 31 October 2016. A medical record review was undertaken to identify comorbidities, operation details, and the perioperative mortality rate. Patient outcomes were classified as alive, dead, or lost to follow-up at 30 days and 1 year.

Results: There were 152 patients, including 90 men (59%), and the median age was 60 years. Comorbidity data were available for 137 patients (90%). One hundred eight patients (79%) had peripheral vascular disease, and 91 (66%) had diabetes mellitus. Fifty-three patients (35%) had more than 1 LEA on the same or contralateral limb. There were 183 LEAs performed on 152 patients. The most common LEA was above-knee amputation (n=104, 57%), followed by below-knee amputation (n=36, 20%). For the 30-day mortality analysis, 102 of 152 patients (67%) were traced, and 12 (12%) had died within 30 postoperative days. For the 1-year mortality analysis, 86 (57%) were traced, and 37 (43%) had died within 1 postoperative year.

Conclusions: At this second-level South African hospital, 43% of patients who underwent LEA during the investigated period were dead after 1 year. In resource-constrained settings, mortality data are necessary when considering resource allocation for LEA and essential surgical care packages.


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