Title: Mortality and Hospitalization in Patients After Amputation
Authors: Schofield, CJ., Libby, G., Brennan, GM., MacAlpine, RR., Morris, AD., Leese, GP.
Source: Diabetes Care, 29(10):2252-2256, 2006.
PODIATRIC RELEVANCE:
The emphasis of prevention of diabetic foot ulceration involves the relief of pressure, ischemia, infection and regular primary foot care. Even when attention is on these specific areas of care, diabetics are much more likely to experience lower extremity amputation than non diabetics with ulceration due to cardiovascular risk factors that lead to mortality.
METHODS:
This was a retrospective cohort study that took place in Tayside, Scotland in a fixed population that included all residents who were registered with a Tayside general practitioner. The residents had resided in Tayside from January 1992 until March 31, 1998 or were deceased during this time. Every patient received a community health number. Patients with diabetes were identified using the Diabetes Audit and Research in Tayside, Scotland (DARTS). A lower extremity amputation (LEA) was defined as the complete loss in the transverse anatomical plane of any part of the lower limb. The primary data source was the Scottish Morbidity Record 1 (SMR1) database. A case was defined as any patient who underwent any LEA in a Tayside hospital during the period January 1, 1992 until December 31, 1995. A minor amputation was distal to the ankle joint. A major amputation was any amputation through or proximal to the ankle joint. The primary end point was mortality after the first LEA. Secondary end points were the time until hospitalization following the first LEA.
RESULTS:
390 lower extremity amputations were performed during the study period. 119 (30.5%) were in diabetics and 271 (69.5%) were in non diabetics. The diabetic median survival (50%) was 27.2 months compared with 46.7 months for non diabetic patients. Diabetic patients had a 55% greater risk of death than those without diabetes. Also the risk of developing congestive heart failure with diabetes was 2.26 times and further amputation 1.95 times that of non diabetics. The median length of time from discharge to admission with peripheral vascular disease was longer in patients with diabetes than those without.
COMMENTS:
Patients with diabetes have a high morbidity and mortality rate after undergoing lower extremity amputation. Efforts should be made to lessen the cardiovascular risks with aggressive treatment post operatively, however prevention of foot ulceration and amputation should be of paramount importance.
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Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.