Good news, bad news situation: Rates of below-knee amputation among people with diabetes in England have dropped over the past 25 years — but survival outcomes for those who do undergo the procedure remain alarmingly poor, and haven't improved since 2012. A large nationwide cohort study tracking over 25,000 patients found that mortality after below-knee amputation is high and persistent, driven largely by ischaemic heart disease, respiratory illness, and wound-related sepsis.

The study, published in Diabetes Care, spanned procedures from 1998 to 2023 and found that the 90-day readmission rate was over 20%, with common complications including heart attacks, acute kidney injury, and respiratory infections. Female sex, advanced age, and greater comorbidity burden all independently raised the risk of death.

By the Numbers:

• 11.32% mortality by 90 days
• 23.53% mortality by 1 year
• 60.04% mortality by 5 years
• 82.28% mortality by 10 years
• Each additional comorbidity point raised 1-year mortality risk by 4%
• Median hospital stay: 24 days (down from 34 days in 1998)

Why it matters: Despite progress in reducing amputation rates, post-amputation survival has flatlined — signaling an urgent need for structured, multidisciplinary care pathways to improve outcomes for this high-risk population.