Neuropathy and Other Risk Factors for Lower Extremity Amputation in People with Diabetes Using a Clinical Data...

The purpose of the study was to identify the frequency of a prior diagnosis of neuropathy, peripheral vascular disease (PVD), and foot ulceration in patients with diabetes who subsequently underwent lower extremity amputation (LEA).

We performed a retrospective electronic review of de-identified charts from a tertiary medical health center of patients who had the diagnosis codes of diabetes and the procedure codes of LEA. For this query, neuropathy, PVD, and foot ulcer diagnosis codes were selected as the variables of interest. The timeline of events was defined as the first-ever diagnosis of diabetes, followed by the first-ever diagnosis of any of the risk factors, followed by the first-ever procedure of LEA. The frequency of each risk factor was counted individually and the different combinations of risk factors were calculated.

The search yielded 844 patients who had a diabetes diagnosis prior to LEA. We found that 669 (79.3%) of the patients had one or more of the risk factors before LEA. From the 844 patients, 414 (49.1%) had neuropathy, 402 (47.6%) had a foot ulcer, and 495 (58%) had a PVD diagnosis. Investigating the frequency of patients who have multiple risk factors, we found that 28.9% had two risk factors and 23.6% had three risk factors.

The majority of LEA procedures were done for patients with at least one diabetic LEA risk factor. Our findings provide recent quantitative support of known risk factors' association with amputation, and the presence of risk factors war¬rants escalation in prevention strategies.