Introduction

Around 50-60% of ulcers become infected, with approximately 20% of moderate-to-severe infections resulting in lower limb amputation [1]. Consequently, roughly 80% of lower limb amputations are associated with the complications of diabetes mellitus and foot ulceration, both of which significantly elevate the risk for morbidity and mortality. The six-year mortality rate following a major amputation is 72%, underscoring the clinical severity of this condition [2]. Furthermore, evidence indicates that hospitalized patients with diabetic foot complications experience a 12.5% rate of adverse cardiovascular events and a 4.4% mortality rate. Notably, cases involving distal arterial obstructions require more frequent vascular interventions than those involving other pathological patterns [3].

The one-year mortality rate for diabetic patients undergoing hemodialysis is 33.8%, compared to 17.6% for those not on dialysis. At three, five, and seven years, mortality rates remain significantly higher in the hemodialysis group (58.8%, 69.9%, and 87.6%, respectively) than in the non-dialysis group (37.0%, 50.5%, and 64.4%, respectively). Furthermore, the median survival time is significantly shorter for patients on hemodialysis at 27.1 months, compared to 47.7 months for those not on dialysis (p < 0.001) [4]. Independent predictors of major amputation include the presence of extensive pedal arterial occlusive disease (desert foot), persistent post-procedure pain, heel involvement with multiple ulcers, and the inability to stand or walk without assistance [5].

One study suggests that while endovascular and open limb revascularization procedures do not significantly impact major amputation or mortality rates, bypass surgery is associated with a significantly lower postoperative reintervention rate [6]. Currently, there is no evidence to reliably conclude that angioplasty with conventional stenting, drug-eluting balloon angioplasty, or atherectomy is superior to conventional balloon angioplasty in preventing major amputations and deaths in patients with chronic limb-threatening ischemia [7].

Regarding lifestyle and demographic factors, former smokers undergoing lower limb revascularization show five-year outcomes similar to non-smokers, with better overall and progression-free survival compared to active smokers [8]. Gender-based differences are also observed. Women are more likely to die within 30 days, whereas men have higher rates of reintervention; however, limb salvage rates are higher in women [9]. Additionally, frailty independently predicts short- and long-term all-cause mortality, though not with major amputations, in patients with peripheral arterial disease, serving as a critical factor for risk stratification [10].

This study aimed to evaluate perioperative mortality following major lower limb amputations performed between 2010 and 2024 at the Hospital de Base of the Faculty of Medicine of São José do Rio Preto (FAMERP), Brazil.