[Risk factors for major lower limb amputations in diabetic patients hospitalized for diabetic foot ulcer]

Amputations in diabetes patient lead to high postoperative morbidity and mortality .

To indentify the risk factors for major lower limb amputations in diabetic patients hospitalized in endocrinology department.

It was a descriptive retrospective study including diabetic patients hospitalized in the endocrinology department of the Rabta Hospital for management of an infected foot lesion. We distributed the patients into 2 groups: group 1: patients with major amputation of the lower limb and group 2: patients who have had an amputation below the ankle or who had a conservative treatment.

One hundred and twenty patients were included. The mean age was 59 ±11.9 years [28-97]. Twenty one (17.5%) patients had a major amputation (group 1). The frequency of obliterating arterial disease and gangrenes of the lower limbs were significantly higher in group 1. The extent of lesions> 2cm and the frequency of osteitis were comparable between the two groups. The frequency of hyperleukocytosis and mean C reactive protein were significantly higher in group 1. Antibiotic therapy prescribed during hospitalization was targeted in 30% of cases in group 1 versus 12.9% in group 2 (p = 0.05). Obliterating arterial disease, gangrenes and long duration of diabetes were independant risk factors significant on binary regression analysis.

Some risk factors associated with major amputations are modifiable, such as arteriopathy obliterating of the lower limbs. A larger and prospective study would allow a better analysis of the predictive factors of major amputations.