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

Chloé Ml Peters*, Jolanda De Vries, Eelco J Veen, Hans Gw De Groot, Gwan H Ho, Paul Lodder, Stijn L Steunenberg, Lijckle Van Der Laan

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

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Abstract

Purpose:
Despite high amputation rates, data on patient-reported outcomes is scarce in the elderly population with critical limb ischemia. The aim of this study was to provide mortality rates and long-term changes of the following patient-reported outcomes in elderly critical limb ischemia amputees: quality of life (QoL), health status (HS), and symptoms of depression.

Patients and methods:
In this prospective observational cohort study, amputated critical limb ischemia patients ≥70 years were included. The follow-up period was two years. Within the follow-up period patients completed the following questionnaires: the World Health Organization Quality Of Life -abbreviated version of the WHOQOL 100 (WHOQOL-BREF), the 12-Item Short Form Health Survey, and the Center for Epidemiological Studies Depression Scale.

Results :
A total of 49 elderly patients with critical limb ischemia had undergone major limb amputation within two years after inclusion. In these patients, the one-year mortality rate was 39% and the two-year mortality rate was 55%. The physical QoL was the only domain of the WHOQOL-BREF that improved significantly across time after amputation (p≤0.001). In the long-term, there was no difference in the ability to enjoy life (p=0.380) or the satisfaction in performing daily living activities (p=0.231) compared to the scores of the general elderly population. After amputation, the physical HS domain (p≤0.001) and the mental HS domain (p=0.002) improved. In the first year, amputees experienced less symptoms of depression (p=0.004).

Conclusion:
Elderly critical limb ischemia amputees are a fragile population with high mortality rates. Their QoL and HS increased after major limb amputation as compared to the baseline situation and they experienced less symptoms of depression. Moreover, our results show that, in the long-term, major limb amputation in the elderly patients with critical limb ischemia shows an acceptable QoL, which, in some aspects, is comparable to the QoL of their peers. These results can improve the shared-decision making process that does not delay the timing of major limb amputation.
Original languageEnglish
Pages (from-to)1177-1185
JournalClinical Interventions in Aging
Volume14
DOIs
Publication statusPublished - 2019

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Depression
Health Surveys
Mental Health
Surveys and Questionnaires

Keywords

  • CANCER-PATIENTS
  • DEPRESSION
  • EPIDEMIOLOGY
  • HEALTH-STATUS
  • MORTALITY
  • PERIPHERAL ARTERIAL-DISEASE
  • POPULATION
  • QUALITY-OF-LIFE
  • VALIDITY
  • WHOQOL-BREF
  • amputation
  • critical limb ischemia
  • frail elderly
  • health status
  • quality of life

Cite this

@article{330990e77fb848a6b466be547dde339a,
title = "Is amputation in the elderly patient with critical limb ischemia acceptable in the long term?",
abstract = "Purpose: Despite high amputation rates, data on patient-reported outcomes is scarce in the elderly population with critical limb ischemia. The aim of this study was to provide mortality rates and long-term changes of the following patient-reported outcomes in elderly critical limb ischemia amputees: quality of life (QoL), health status (HS), and symptoms of depression.Patients and methods: In this prospective observational cohort study, amputated critical limb ischemia patients ≥70 years were included. The follow-up period was two years. Within the follow-up period patients completed the following questionnaires: the World Health Organization Quality Of Life -abbreviated version of the WHOQOL 100 (WHOQOL-BREF), the 12-Item Short Form Health Survey, and the Center for Epidemiological Studies Depression Scale.Results : A total of 49 elderly patients with critical limb ischemia had undergone major limb amputation within two years after inclusion. In these patients, the one-year mortality rate was 39{\%} and the two-year mortality rate was 55{\%}. The physical QoL was the only domain of the WHOQOL-BREF that improved significantly across time after amputation (p≤0.001). In the long-term, there was no difference in the ability to enjoy life (p=0.380) or the satisfaction in performing daily living activities (p=0.231) compared to the scores of the general elderly population. After amputation, the physical HS domain (p≤0.001) and the mental HS domain (p=0.002) improved. In the first year, amputees experienced less symptoms of depression (p=0.004).Conclusion: Elderly critical limb ischemia amputees are a fragile population with high mortality rates. Their QoL and HS increased after major limb amputation as compared to the baseline situation and they experienced less symptoms of depression. Moreover, our results show that, in the long-term, major limb amputation in the elderly patients with critical limb ischemia shows an acceptable QoL, which, in some aspects, is comparable to the QoL of their peers. These results can improve the shared-decision making process that does not delay the timing of major limb amputation.",
keywords = "CANCER-PATIENTS, DEPRESSION, EPIDEMIOLOGY, HEALTH-STATUS, MORTALITY, PERIPHERAL ARTERIAL-DISEASE, POPULATION, QUALITY-OF-LIFE, VALIDITY, WHOQOL-BREF, amputation, critical limb ischemia, frail elderly, health status, quality of life",
author = "Peters, {Chlo{\'e} Ml} and {De Vries}, Jolanda and Veen, {Eelco J} and {De Groot}, {Hans Gw} and Ho, {Gwan H} and Paul Lodder and Steunenberg, {Stijn L} and {Van Der Laan}, Lijckle",
year = "2019",
doi = "10.2147/CIA.S206446",
language = "English",
volume = "14",
pages = "1177--1185",
journal = "Clinical Interventions in Aging",
issn = "1176-9092",

}

Is amputation in the elderly patient with critical limb ischemia acceptable in the long term? / Peters, Chloé Ml; De Vries, Jolanda; Veen, Eelco J; De Groot, Hans Gw; Ho, Gwan H; Lodder, Paul; Steunenberg, Stijn L; Van Der Laan, Lijckle.

In: Clinical Interventions in Aging, Vol. 14, 2019, p. 1177-1185.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Is amputation in the elderly patient with critical limb ischemia acceptable in the long term?

AU - Peters, Chloé Ml

AU - De Vries, Jolanda

AU - Veen, Eelco J

AU - De Groot, Hans Gw

AU - Ho, Gwan H

AU - Lodder, Paul

AU - Steunenberg, Stijn L

AU - Van Der Laan, Lijckle

PY - 2019

Y1 - 2019

N2 - Purpose: Despite high amputation rates, data on patient-reported outcomes is scarce in the elderly population with critical limb ischemia. The aim of this study was to provide mortality rates and long-term changes of the following patient-reported outcomes in elderly critical limb ischemia amputees: quality of life (QoL), health status (HS), and symptoms of depression.Patients and methods: In this prospective observational cohort study, amputated critical limb ischemia patients ≥70 years were included. The follow-up period was two years. Within the follow-up period patients completed the following questionnaires: the World Health Organization Quality Of Life -abbreviated version of the WHOQOL 100 (WHOQOL-BREF), the 12-Item Short Form Health Survey, and the Center for Epidemiological Studies Depression Scale.Results : A total of 49 elderly patients with critical limb ischemia had undergone major limb amputation within two years after inclusion. In these patients, the one-year mortality rate was 39% and the two-year mortality rate was 55%. The physical QoL was the only domain of the WHOQOL-BREF that improved significantly across time after amputation (p≤0.001). In the long-term, there was no difference in the ability to enjoy life (p=0.380) or the satisfaction in performing daily living activities (p=0.231) compared to the scores of the general elderly population. After amputation, the physical HS domain (p≤0.001) and the mental HS domain (p=0.002) improved. In the first year, amputees experienced less symptoms of depression (p=0.004).Conclusion: Elderly critical limb ischemia amputees are a fragile population with high mortality rates. Their QoL and HS increased after major limb amputation as compared to the baseline situation and they experienced less symptoms of depression. Moreover, our results show that, in the long-term, major limb amputation in the elderly patients with critical limb ischemia shows an acceptable QoL, which, in some aspects, is comparable to the QoL of their peers. These results can improve the shared-decision making process that does not delay the timing of major limb amputation.

AB - Purpose: Despite high amputation rates, data on patient-reported outcomes is scarce in the elderly population with critical limb ischemia. The aim of this study was to provide mortality rates and long-term changes of the following patient-reported outcomes in elderly critical limb ischemia amputees: quality of life (QoL), health status (HS), and symptoms of depression.Patients and methods: In this prospective observational cohort study, amputated critical limb ischemia patients ≥70 years were included. The follow-up period was two years. Within the follow-up period patients completed the following questionnaires: the World Health Organization Quality Of Life -abbreviated version of the WHOQOL 100 (WHOQOL-BREF), the 12-Item Short Form Health Survey, and the Center for Epidemiological Studies Depression Scale.Results : A total of 49 elderly patients with critical limb ischemia had undergone major limb amputation within two years after inclusion. In these patients, the one-year mortality rate was 39% and the two-year mortality rate was 55%. The physical QoL was the only domain of the WHOQOL-BREF that improved significantly across time after amputation (p≤0.001). In the long-term, there was no difference in the ability to enjoy life (p=0.380) or the satisfaction in performing daily living activities (p=0.231) compared to the scores of the general elderly population. After amputation, the physical HS domain (p≤0.001) and the mental HS domain (p=0.002) improved. In the first year, amputees experienced less symptoms of depression (p=0.004).Conclusion: Elderly critical limb ischemia amputees are a fragile population with high mortality rates. Their QoL and HS increased after major limb amputation as compared to the baseline situation and they experienced less symptoms of depression. Moreover, our results show that, in the long-term, major limb amputation in the elderly patients with critical limb ischemia shows an acceptable QoL, which, in some aspects, is comparable to the QoL of their peers. These results can improve the shared-decision making process that does not delay the timing of major limb amputation.

KW - CANCER-PATIENTS

KW - DEPRESSION

KW - EPIDEMIOLOGY

KW - HEALTH-STATUS

KW - MORTALITY

KW - PERIPHERAL ARTERIAL-DISEASE

KW - POPULATION

KW - QUALITY-OF-LIFE

KW - VALIDITY

KW - WHOQOL-BREF

KW - amputation

KW - critical limb ischemia

KW - frail elderly

KW - health status

KW - quality of life

U2 - 10.2147/CIA.S206446

DO - 10.2147/CIA.S206446

M3 - Article

VL - 14

SP - 1177

EP - 1185

JO - Clinical Interventions in Aging

JF - Clinical Interventions in Aging

SN - 1176-9092

ER -