Life Expectancy Score in Lower Extremity/Limb Amputation: A Meta-Analysis

Abstract

Lower limb amputations (LEA) are commonly performed to control pain and sepsis in non-viable limbs among patients with chronic limb-threatening ischemia secondary to peripheral arterial disease. Despite advances in surgical technique and perioperative care, LEA remains associated with high short- and long-term mortality. The objective of this research is to estimate pooled mortality rates following LEA and to develop a composite life expectancy stratification framework based on age, level of amputation, and diabetes mellitus. This meta-analysis was conducted using electronic searches of EMBASE, Scopus, CINAHL, the Cochrane Library, and Google Scholar. Mortality rates were analysed at 30 days, 1 year, 2 years, 3 years, and 5 years following amputation. Mortality was further stratified by patient age, amputation level, and diabetes status. These variables were integrated into a composite Life Expectancy Score to stratify mortality risk.. Thirty-day mortality ranged from 8.1% to 30.0%, with higher mortality observed after above-knee amputation (AKA) compared with below-knee amputation (BKA) (17.9% vs. 10.1%). One-year mortality approached 50% following AKA compared with approximately 33% after BKA, while five-year mortality exceeded 75% for AKA patients. Advanced age (≥85 years) and diabetes mellitus were consistently associated with increased mortality across all follow-up intervals. When combined into a Life Expectancy Score, patients could be stratified into low-, intermediate-, high-, and very high-risk groups, with estimated 1-year mortality ranging from approximately 15–20% in low-risk patients to ≥60% in very high-risk patients, and 5-year mortality reaching to 85–90% in the highest-risk group. Mortality following LEA remains substantial, particularly among elderly and diabetic patients undergoing major amputations. A composite Life Expectancy Score incorporating age, amputation level, and diabetes status provides a pragmatic framework for stratifying post-amputation survival and may assist clinicians in prognostic counselling and shared decision-making.