Health Related Quality of Life Outcomes after Lower Extremity Amputation

Nike Walter; Marion Görlich; Carl Zülke; Melanie Ardelt; Silvan Klein; Volker Alt; Karin Pfister; Markus Rupp

doi:10.1016/j.ejvs.2026.01.027

Health Related Quality of Life Outcomes after Lower Extremity Amputation

Nike Walter
, Marion Görlich
, Carl Zülke
, Melanie Ardelt
, Silvan Klein
, Volker Alt
, Karin Pfister
, Markus Rupp

Division of Orthopaedics and Traumatology (University Hospital Krems)

Research output: Journal article (peer-reviewed) › Journal article

Abstract

OBJECTIVE: Lower limb amputation profoundly impairs health related quality of life (HRQoL), yet comparative data across indications and amputation levels are scarce. This study evaluated EQ-5D-3L outcomes in patients with and without ischaemia undergoing major vs. minor lower extremity amputations.

METHODS: In this retrospective cohort at a German level 1 trauma centre, patients (during 2010 - 2020) were classified by indication (ischaemia vs. trauma/tumour/infection) and amputation level (major vs. minor). Between 2023 and 2024, EQ-5D-3L interviews assessed five HRQoL dimensions. Multivariable linear regression identified independent predictors of EQ-5D index scores.

RESULTS: Of 1 075 eligible patients, 276 (25.7%) completed EQ-5D: 176 with ischaemia (124 minor and 53 major) and 100 with other indications (55 minor and 44 major). Mobility limitations were more frequent in major vs. minor amputees for both ischaemia (71.7% vs. 62.1%) and other indications (75.0% vs. 41.8%). Self care was least affected (ischaemia majors 47.2% no problems; minors 60.5%; other majors 51.2%; minors 80.0%). Pain/discomfort was reported by 77.4% of ischaemia majors and 52.8% of ischaemia minors, and by 68.2% and 58.2% of other majors and minors, respectively. Anxiety/depression impairment was intermediate across groups. In patients with ischaemia, higher American Society of Anesthesiologists (ASA) score (β = -6.05, p = .001) and dialysis status (β = 3.47, p = .15) strongly predicted EQ-5D, whereas amputation level did not (β = -2.50, p = .32). In patients without ischaemia, coronary heart disease (β = -10.47, p < .001) and major amputation (β = -8.47, p = .006) were key negative predictors.

CONCLUSION: HRQoL impairments after lower limb amputation vary by indication and level, with comorbidity burden, especially ASA score and coronary disease, exerting greater influence than amputation level alone. These findings support multidisciplinary optimisation of systemic health in amputation care.

Original language	English
Journal	European Journal of Vascular and Endovascular Surgery
DOIs	https://doi.org/10.1016/j.ejvs.2026.01.027
Publication status	E-pub ahead of print - 21 Jan 2026

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10.1016/j.ejvs.2026.01.027

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@article{56345d08f639484aa2a005a65edad62e,

title = "Health Related Quality of Life Outcomes after Lower Extremity Amputation",

abstract = "OBJECTIVE: Lower limb amputation profoundly impairs health related quality of life (HRQoL), yet comparative data across indications and amputation levels are scarce. This study evaluated EQ-5D-3L outcomes in patients with and without ischaemia undergoing major vs. minor lower extremity amputations.METHODS: In this retrospective cohort at a German level 1 trauma centre, patients (during 2010 - 2020) were classified by indication (ischaemia vs. trauma/tumour/infection) and amputation level (major vs. minor). Between 2023 and 2024, EQ-5D-3L interviews assessed five HRQoL dimensions. Multivariable linear regression identified independent predictors of EQ-5D index scores.RESULTS: Of 1 075 eligible patients, 276 (25.7\%) completed EQ-5D: 176 with ischaemia (124 minor and 53 major) and 100 with other indications (55 minor and 44 major). Mobility limitations were more frequent in major vs. minor amputees for both ischaemia (71.7\% vs. 62.1\%) and other indications (75.0\% vs. 41.8\%). Self care was least affected (ischaemia majors 47.2\% no problems; minors 60.5\%; other majors 51.2\%; minors 80.0\%). Pain/discomfort was reported by 77.4\% of ischaemia majors and 52.8\% of ischaemia minors, and by 68.2\% and 58.2\% of other majors and minors, respectively. Anxiety/depression impairment was intermediate across groups. In patients with ischaemia, higher American Society of Anesthesiologists (ASA) score (β = -6.05, p = .001) and dialysis status (β = 3.47, p = .15) strongly predicted EQ-5D, whereas amputation level did not (β = -2.50, p = .32). In patients without ischaemia, coronary heart disease (β = -10.47, p < .001) and major amputation (β = -8.47, p = .006) were key negative predictors.CONCLUSION: HRQoL impairments after lower limb amputation vary by indication and level, with comorbidity burden, especially ASA score and coronary disease, exerting greater influence than amputation level alone. These findings support multidisciplinary optimisation of systemic health in amputation care.",

author = "Nike Walter and Marion G{\"o}rlich and Carl Z{\"u}lke and Melanie Ardelt and Silvan Klein and Volker Alt and Karin Pfister and Markus Rupp",

year = "2026",

month = jan,

day = "21",

doi = "10.1016/j.ejvs.2026.01.027",

language = "English",

journal = "European Journal of Vascular and Endovascular Surgery",

issn = "1078-5884",

publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Health Related Quality of Life Outcomes after Lower Extremity Amputation

AU - Walter, Nike

AU - Görlich, Marion

AU - Zülke, Carl

AU - Ardelt, Melanie

AU - Klein, Silvan

AU - Alt, Volker

AU - Pfister, Karin

AU - Rupp, Markus

PY - 2026/1/21

Y1 - 2026/1/21

N2 - OBJECTIVE: Lower limb amputation profoundly impairs health related quality of life (HRQoL), yet comparative data across indications and amputation levels are scarce. This study evaluated EQ-5D-3L outcomes in patients with and without ischaemia undergoing major vs. minor lower extremity amputations.METHODS: In this retrospective cohort at a German level 1 trauma centre, patients (during 2010 - 2020) were classified by indication (ischaemia vs. trauma/tumour/infection) and amputation level (major vs. minor). Between 2023 and 2024, EQ-5D-3L interviews assessed five HRQoL dimensions. Multivariable linear regression identified independent predictors of EQ-5D index scores.RESULTS: Of 1 075 eligible patients, 276 (25.7%) completed EQ-5D: 176 with ischaemia (124 minor and 53 major) and 100 with other indications (55 minor and 44 major). Mobility limitations were more frequent in major vs. minor amputees for both ischaemia (71.7% vs. 62.1%) and other indications (75.0% vs. 41.8%). Self care was least affected (ischaemia majors 47.2% no problems; minors 60.5%; other majors 51.2%; minors 80.0%). Pain/discomfort was reported by 77.4% of ischaemia majors and 52.8% of ischaemia minors, and by 68.2% and 58.2% of other majors and minors, respectively. Anxiety/depression impairment was intermediate across groups. In patients with ischaemia, higher American Society of Anesthesiologists (ASA) score (β = -6.05, p = .001) and dialysis status (β = 3.47, p = .15) strongly predicted EQ-5D, whereas amputation level did not (β = -2.50, p = .32). In patients without ischaemia, coronary heart disease (β = -10.47, p < .001) and major amputation (β = -8.47, p = .006) were key negative predictors.CONCLUSION: HRQoL impairments after lower limb amputation vary by indication and level, with comorbidity burden, especially ASA score and coronary disease, exerting greater influence than amputation level alone. These findings support multidisciplinary optimisation of systemic health in amputation care.

AB - OBJECTIVE: Lower limb amputation profoundly impairs health related quality of life (HRQoL), yet comparative data across indications and amputation levels are scarce. This study evaluated EQ-5D-3L outcomes in patients with and without ischaemia undergoing major vs. minor lower extremity amputations.METHODS: In this retrospective cohort at a German level 1 trauma centre, patients (during 2010 - 2020) were classified by indication (ischaemia vs. trauma/tumour/infection) and amputation level (major vs. minor). Between 2023 and 2024, EQ-5D-3L interviews assessed five HRQoL dimensions. Multivariable linear regression identified independent predictors of EQ-5D index scores.RESULTS: Of 1 075 eligible patients, 276 (25.7%) completed EQ-5D: 176 with ischaemia (124 minor and 53 major) and 100 with other indications (55 minor and 44 major). Mobility limitations were more frequent in major vs. minor amputees for both ischaemia (71.7% vs. 62.1%) and other indications (75.0% vs. 41.8%). Self care was least affected (ischaemia majors 47.2% no problems; minors 60.5%; other majors 51.2%; minors 80.0%). Pain/discomfort was reported by 77.4% of ischaemia majors and 52.8% of ischaemia minors, and by 68.2% and 58.2% of other majors and minors, respectively. Anxiety/depression impairment was intermediate across groups. In patients with ischaemia, higher American Society of Anesthesiologists (ASA) score (β = -6.05, p = .001) and dialysis status (β = 3.47, p = .15) strongly predicted EQ-5D, whereas amputation level did not (β = -2.50, p = .32). In patients without ischaemia, coronary heart disease (β = -10.47, p < .001) and major amputation (β = -8.47, p = .006) were key negative predictors.CONCLUSION: HRQoL impairments after lower limb amputation vary by indication and level, with comorbidity burden, especially ASA score and coronary disease, exerting greater influence than amputation level alone. These findings support multidisciplinary optimisation of systemic health in amputation care.

U2 - 10.1016/j.ejvs.2026.01.027

DO - 10.1016/j.ejvs.2026.01.027

M3 - Journal article

C2 - 41577118

SN - 1078-5884

JO - European Journal of Vascular and Endovascular Surgery

JF - European Journal of Vascular and Endovascular Surgery

ER -

Health Related Quality of Life Outcomes after Lower Extremity Amputation

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