A 25-year national study from Oxford researchers, published online September 14 in Diabetes Care, tracked deaths among people with diabetes who had a below-knee amputation in England. By five years, 60.0% had died, and survival has not improved since 2012.
If you or a family member has diabetes, the practical message is about timing. Look at the feet every day. Get any sore, blister or cut that is not healing seen quickly, rather than waiting. And if amputation is ever raised, it is fair to ask whether blood flow to the leg has been fully assessed by a vascular specialist. This study does not show which treatment is right for any one person. That decision belongs with you and your doctors.
Key takeaways
- Death rates after below-knee amputation in people with diabetes were 23.5% at 1 year, 60.0% at 5 years and 82.3% at 10 years.
- Within 90 days of surgery, about 1 in 5 (20.25%) were readmitted to the hospital and 3.74% had a heart attack.
- Survival has not improved since 2012.
What the study found
The team, from the Nuffield Orthopaedic Centre and the University of Oxford, used national hospital records in England linked to death records. They followed 25,176 people with diabetes who had 28,232 below-knee amputations. The authors describe this as the most common major amputation for advanced diabetic foot disease.
The main results:
- Survival: 23.5% had died at 1 year, 60.0% at 5 years and 82.3% at 10 years. Put another way, about 235 of every 1,000 people died in the first year.
- No progress: the death rate has not improved since 2012.
- Within 90 days: 20.25% were readmitted, 6.24% needed another operation and 3.74% had a heart attack.
- The other leg: by 5 years, 6.43% had an amputation of the opposite leg, about 64 in every 1,000 (very likely between 6.14% and 6.73%).
Three things were tied to a higher risk of death:
- Older age: about 62% higher risk (hazard ratio 1.62, very likely between 56% and 69% higher).
- Female sex: about 6% higher risk (hazard ratio 1.06, very likely between 3% and 10% higher).
- More health conditions: about 4% higher risk for each added point on a standard illness score, the Charlson Comorbidity Index (hazard ratio 1.04 per point).
These are relative figures that compare groups within the study.
Dr. Kumar’s take
A 10-year death rate of 82.3% is the kind of number people expect to hear about a serious cancer, not a foot problem. Yet diabetic foot disease rarely gets that level of urgency.
The survival figure is easy to misread. It sounds like the operation itself is what kills people. A below-knee amputation is major surgery, but in people with diabetes it usually comes at the end of a long process: damaged nerves, poor blood flow and wounds that will not heal. The same patients also had a 3.74% heart attack rate within 90 days, meaning about 1 in 27 had a heart attack in that window. This is an observational records study, so it cannot prove what caused each death.
The flat line since 2012 is the other hard finding. Whatever changed in care over that stretch, survival after this operation did not improve. That points the effort earlier, to the foot ulcer, long before anyone is in an operating room. An amputation also should not close the chapter. It is a signal to take heart and artery risk seriously, and many of those drivers can be changed, as I covered in nearly 9 in 10 US heart disease deaths are preventable.
Caveats matter. The data come from England and rely on hospital coding. The study describes what happened; it did not test any way to prevent amputation or death. It cannot tell you your own odds.
What it means for you
If you or someone you care for has diabetes:
- Check the feet daily. Look for sores, blisters, cuts, swelling or color changes, including between the toes and on the soles.
- Treat a wound that is not healing as urgent. Get it seen quickly rather than waiting to see if it clears up.
- If amputation comes up, ask about circulation first. Has blood flow to the leg been formally tested? Is a vascular assessment or a procedure to restore flow an option?
- After an amputation, keep the focus on the heart. Ask what heart and artery risk looks like now.
This study does not tell anyone to refuse or demand a specific surgery. It supports taking foot problems seriously early, and leaving the treatment decision to a conversation with your care team.