Analysis of systemic risk factors between diabetic/vascular patients having primary lower limb amputations and re-amputations

Abstract

Background: Patients with diabetes mellitus (DM) are known to be predisposed to many complications in the lower extremities such as neuropathy, peripheral artery disease (PAD) and infection. Diabetic foot ulcers are complications of diabetes that can lead to lower extremity amputations, re-amputations and high mortality rates. Purpose: The aim of this study is to evaluate the risk factors associated with higher re-amputation rates in diabetic foot disease. Research Design: This is a mono-centric retrospective comparative study. Study Sample: the study included 136 patients, with a total of 193 procedures (111 primary amputations and 82 re-amputations) between 2011 and 2021. Data Analysis: The t-student test and Spearman correlation were used to look for mean differences and any relevant association, respectively. Multivariate logistic regression analysis was computed to look for independent variables. Results: Twenty-two (27%) and 60 (50%) of those who had major and minor amputations, respectively, had a re-amputation ( p = 0.006). Besides diabetes (89%), the commonest risk factor associated with amputation was hypertension (86.7%), be it for primary amputation or re-amputation, followed by peripheral (PAD) and coronary artery diseases. Only three risk factors showed independent correlation with re-amputation; chronic kidney disease (r = 15%,  p = 0.03), smoking (r = 15%,  p = 0.03), and simultaneous presence of DM + PAD (r = 13.7%,  p = 0.05). Conclusions: Factors that were significantly correlated with increased re-amputation rates have a clear pathologic pathway that affects vascularity and wound healing. Further studies should be aimed at developing a clear scoring system that can be used to stratify patient for re-amputation risk, and to better predict the results according to the severity of diabetes.