Five-Day Postoperative Mortality Following Lower Limb Amputation for Diabetic Gangrene at the Rivers State University Teaching Hospital, Port Harcourt, Nigeria: A Retrospective Study

Background: Diabetic foot disease is an important cause of lower limb amputation and death, particularly in low- and middle-income settings where late presentation, advanced infection, peripheral arterial disease and limited access to coordinated foot-care services remain important challenges. This study estimated cumulative mortality during the first five postoperative days among patients who underwent lower limb amputation for diabetic gangrene.
Materials and Methods: This was a retrospective observational study of patients who underwent lower limb amputation for diabetic gangrene at the Rivers State University Teaching Hospital, Port Harcourt, Nigeria, from January 2017 to December 2022. The mortality analysis comprised 152 patients whose indication for amputation was diabetic foot gangrene. Five postoperative days was used as a pragmatic observation window because mortality status was available cumulatively through postoperative day 5, whereas exact day-specific death dates and standardized later follow-up were not available in the secondary dataset. The primary outcome was therefore cumulative five-day postoperative mortality. Data were summarized using frequencies and percentages, and the 95% confidence interval (CI) was estimated using the Wilson method.
Results: Sixty-nine of the 152 patients died on or before postoperative day 5, giving a cumulative five-day postoperative mortality of 45.4% (95% CI: 37.7-53.3%). Eighty-three patients (54.6%) were alive beyond postoperative day 5. The parent amputation study contained aggregate age, sex and amputation-level data for all 226 amputees, but these variables were not stratified by diabetic status or survival outcome and could not be used for patient-level mortality analysis.
Conclusion: Cumulative five-day postoperative mortality after lower limb amputation for diabetic gangrene was high in this cohort. The result describes mortality occurring after surgery but does not establish that amputation caused the deaths. Earlier diabetic foot detection and referral, prompt management of infection and ischaemia, perioperative optimisation and close postoperative surveillance are important areas for service improvement. Prospective or patient-level retrospective studies are needed to determine the timing, causes and independent predictors of early mortality.

Diabetic gangrene; diabetic foot; lower limb amputation

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