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Published on: September 22, 2020
Perioperative Risk Factors for Early Major Amputation Following First-Time Diabetic Forefoot Amputation
Jae Hyeon Seo1,2, Ho Seong Lee2, Young Rak Choi2
1Naval Pohang Hospital, Republic of Korea Navy, Pohang, Republic of Korea.
Insights
Chronic renal failure, peritoneal dialysis, and bilateral amputations are key risk factors for early major amputation after diabetic forefoot surgery. These findings are crucial for improving limb salvage outcomes in diabetic patients.
Area of Science:
- Diabetes Mellitus Research
- Nephrology
- Vascular Surgery
Background:
- Limb salvage after diabetic forefoot amputation is challenging.
- Predictors of early failure in limb salvage strategies are not well understood.
Purpose of the Study:
- To identify perioperative independent risk factors for major amputation within one year following initial diabetic forefoot amputation.
Main Methods:
- Analysis of perioperative variables from 808 diabetic forefoot amputations.
- Cox proportional hazards models used to assess risk factors for major amputation within one year.
Main Results:
- Chronic renal failure (CRF), peritoneal dialysis, and bilateral initial amputations were significant risk factors for early major amputation.
- CRF demonstrated a hazard ratio of 2.973, peritoneal dialysis 2.558, and bilateral amputation 2.515.
Conclusions:
- Chronic renal failure is a strong predictor of major amputation within one year, irrespective of kidney transplantation status.
- Identifying these risk factors can help optimize limb salvage strategies for diabetic patients.
Background:
Despite a meticulous multidisciplinary team approach, limb salvage remains uncertain even after the initial forefoot amputation in patients with end-stage diabetes. Which of many factors strongly influence the early failure of the limb salvage strategy remains unknown. This study aimed to analyze perioperative independent risk factors for major amputation within 1 year following first-time diabetic forefoot amputation.
Methods:
Perioperative variables of 808 diabetic forefoot amputations performed in a tertiary referral center specialized for organ transplantation and end-stage diabetes were analyzed. Major amputations were performed in 104 patients (12.9%) throughout follow-up, and 77 (74%) of 104 patients had their major amputation within 1 year. Cox proportional hazards were examined to assess the risk factors for major amputation performed within 1 year.
Results:
In univariate analysis, 18 possible risk factors significantly differed between patients with and without early major amputation. In stepwise multivariable analysis, chronic renal failure (CRF), peritoneal dialysis, and bilateral initial amputation were strong risk factors for early major amputation, with hazard ratios of 2.973 (95% CI 1.805-4.896, P < .0001), 2.558 (95% CI 1.113-5.881, P = .027), and 2.515 (95% CI 1.318-4.798, P = .005), respectively.
Conclusion:
Regardless of kidney transplantation (KT) status, CRF strongly predicts >20% chance of major amputation within 1 year after the first diabetic forefoot amputation.
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