Revision Rate and Risk Factors After Lower Extremity Amputation in Diabetic or Dysvascular Patients

This article reports the revision rate and possible risk factors for lower extremity amputations in patients with diabetes mellitus or peripheral arterial disease (PAD). Data were collected from 421 patients with diabetes mellitus or PAD who underwent amputations of the lower extremity at the authors' institution from 2002 to 2012. There was a 25.2% overall revision rate. Mean time from amputation to revision was 244 days (range, 2-2590 days). Patients with diabetes mellitus had a significantly higher rate of revision to a more proximal level compared with patients without diabetes mellitus (type 1: odds ratio [OR]=3.73; 95% confidence interval [CI], 1.21-11.52; P=.022; and type 2: OR=2.3; 95% CI, 1.07-4.95; P=.033). A significant increase in revision rates was observed from Fontaine stage 0 to IV (stage 0: 17.9%; stage IV, 34.7%; P=.03). Risk factors for revision were diabetic nephropathy (OR=2.26; 95% CI, 1.4-3.63; P=.001) and polyneuropathy (OR=1.68; 95% CI, 1.03-2.73; P=.037). Patients who underwent revision amputation had a significantly younger mean age than patients who did not undergo revision amputation (65.23 years [range, 40-92 years] vs 68.52 years [range, 32-96 years]; P=.013). Anticipated amputation in this patient population requires a multidisciplinary approach with optimization of the patient's health. In the authors' clinical practice, the determination of the appropriate amputation level is performed individually for each patient, considering the risk factors identified in this study and the patient's expected mobilization potential, social background, and acceptance of a more proximal primary amputation level.