Elsevier

The Journal of Foot and Ankle Surgery

Volume 56, Issue 6, November–December 2017, Pages 1218-1222
The Journal of Foot and Ankle Surgery

Original Research
Predictors of Lower Extremity Amputation and Reamputation Associated With the Diabetic Foot

https://doi.org/10.1053/j.jfas.2017.06.004Get rights and content

Abstract

In the present study, we aimed to identify the comorbidities that would be predictive of requiring lower extremity amputation or reamputation for diabetic foot wounds. We performed a retrospective review of 132 consecutive patients who had undergone lower extremity amputations (110 patients) or reamputations (22 patients) for diabetic wounds from January 2013 to March 2016. We used multivariate logistic regression to calculate the odds ratios (ORs) for amputation and reamputation for various comorbidities. The ORs of undergoing amputation were greatest for adult males (OR 5.12, 95% confidence interval [CI] 1.56 to 13.04; p = .05) and those with longer term diabetes (OR 4.22, 95% CI 2.01 to 12.95; p = .05), wound infection (OR 3.94, 95% CI 1.04 to 9.00; p = .05), diabetic neuropathy (OR 3.53, 95% CI 1.07 to 9.11; p = .05), and a positive history of smoking (OR 3.04, 95% CI 1.55 to 9.89; p = .05). Similarly, the ORs of undergoing reamputation were greatest for adult males (OR 4.06, 95% CI 1.02 to 12.08; p = .05) and those with longer term diabetes (OR 3.67, 95% CI 1.94 to 11.42; p = .05), wound infection (OR 3.12; 95% CI 0.9 to 8.32; p = .05), diabetic neuropathy (OR 3.01, 95% CI 0.92 to 8.54; p = .05), and a positive history of smoking (OR 2.89, 95% CI 1.09 to 9.42; p = .05). The early identification of these comorbidities could help determine which patients are most likely to require amputation or reamputation.

Section snippets

Patients and Methods

We performed a retrospective review of the records of 132 consecutive patients who had undergone lower extremity amputation or reamputation as a result of diabetic wounds at Konya Necmettin Erbakan University Meram Medical Faculty Hospital from January 2013 to March 2016. Two surgeons (E.A., B.K.K.) performed all record reviews and surgeries. All the patients provided written informed surgical consent. The institutional review board approved our study protocol, and the study was conducted in

Results

The mean follow-up period of the patients was 20 (range 14 to 27) months. Of 132 patients, 110 had undergone an initial amputation and 22, a reamputation (Table 1). The mean age of all the patients was 64.3 (range 27 to 89) years. Of the 132 patients, 90 were male and 42 were female. The mean diabetes duration was 10.5 years in the amputation group and 11.5 years in the reamputation group. Of the 132 patients, 20 had culture-positive wound infections (Fig. 1, Fig. 2), and 18 had culture

Discussion

In our study, the significant predictors for either amputation or reamputation were similar. The strongest predictors for requiring surgery in both groups were male gender, longer diabetes duration, wound infection, diabetic neuropathy, and positive smoking history. The ORs for each of these comorbidities in the amputation group were generally greater than the ORs in the reamputation group. Tükenmez et al (10) identified hypertension, coronary artery disease, and leukocytosis as the most common

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  • Cited by (46)

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    Financial Disclosure: None reported.

    Conflict of Interest: None reported.

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