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.
Level of Clinical Evidence
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- Orv Hetil. 2017; 158 ([Hungarian]): 203-211
- Foot ulcer risk is lower in South-Asian and American Caribbean compared with European diabetic patients in the UK: the Northwest Diabetes Foot Care Study.Diabetes Care. 2005; 28: 1869-1875
- Outcomes following advanced wound care for diabetic foot ulcers: a Canadian study.Can J Diabetes. 2017; 41: 26-32
- Losing a foot versus losing a dollar: a systematic review of cost studies in diabetic foot complications.Expert Rev Pharmacoecon Outcomes Res. 2017; 17: 165-180
- Diabetic foot ulcer development risk classifications' validation: a multicentre prospective cohort study.Diabetes Res Clin Pract. 2017; 127: 105-114
- The impact of diabetes related lower-extremity amputations in the Netherlands.J Intern Med. 1996; 10: 325-330
- A meta-analysis of long-term mortality and associated risk factors following lower extremity amputation.Ann Vasc Surg. 2017; 42: 322-327
- Amputation risk in patients with diabetes mellitus and peripheral artery disease using statewide data.Ann Vasc Surg. 2016; 30: 123-131
- The incidence and risks of failure to heal after lower extremity amputation for the treatment of diabetic neuropathic foot ulcer.J Foot Ankle Surg. 2006; 45: 366-374
Tükenmez M, Cekin T, Karatas C, Percin S, Tezeren G. Diyabetik Ayakta Alt Ekstremite Amputasyonları [Lower limb amputations in diabetic foot]. Cumhuriyet Üniversitesi Tıp Fakültesi Dergisi [CÜ Medicine Magazine] 27:100–104, 2005 [Turkish].
- Lower limb amputation for diabetic foot.Arch Orthop Trauma Surg. 2001; 121: 186-190
- Diabetic foot classifications: review of literature.Med Sci. 2013; 2: 715-721
- Comparison of four systems of classification of diabetic foot ulcers in Tanzania.Diabet Med. 2008; 25: 134-137
- Prognostic value of systolic ankle and toe blood pressure levels in outcome of diabetic foot ulcer.Diabetes Care. 1989; 12: 373-378
- Classification systems.in: Nather A. Diabetic Foot Problems. World Scientific, London2008: 87-106
- Comparison of five systems of classification of diabetic foot ulcers and predictive factors for amputation.Int Wound J. 2017; 14: 537-545
- Classification systems for lower extremity amputation prediction in subjects with active diabetic foot ulcer: a systematic review and meta-analysis.Diabetes Metab Res Rev. 2014; 30: 610-622
- Comparing the Meggitt-Wagner and the University of Texas wound classification systems for diabetic foot ulcers: inter-observer analyses.Int Wound J. 2016; 13: 1137-1141
- Surgical management of the diabetic foot.Br J Hosp Med. 1976; 16: 227-232
- Explaining odds ratios.J Can Acad Child Adolesc Psychiatry. 2010; 19: 227-229
- Risk of reamputation in diabetic patients stratified by limb and level of amputation: a 10-year observation.Diabetes Care. 2006; 29: 566-570
- Clinical reliability and utility of skin perfusion pressure measurement in ischemic limbs—comparison with other noninvasive diagnostic methods.J Vasc Surg. 2008; 47: 318-323
- Procalcitonin as a biomarker for predicting amputation level in lower extremity infections.J Foot Ankle Surg. 2017; 56: 484-491
Published online: July 29, 2017
Financial Disclosure: None reported.
Conflict of Interest: None reported.
© 2017 by the American College of Foot and Ankle Surgeons. All rights reserved.