Comorbidity and risk factors of subsequent lower extremity amputation in patients diagnosed with diabetes in Saskatchewan, Canada

Abstract

Objective Subsequent limb amputation (SLA) may be necessary due to disease progression, infection, or to aid prosthesis fit. SLA in Saskatchewan has increased 3.2% from 2006 to 2019 with minor SLA increasing 9.6% during that period. Diabetes affects a large proportion of patients who require SLA; however, the impact of additional comorbidities is not clear. Methods First-episode subsequent lower extremity limb amputation (SLEA) cases with the presence/absence of diabetes, other comorbidities, and demographic characteristics from 2006–2019 were retrieved from Saskatchewan's Discharge Abstract Database. Logistic regression was performed to examine the magnitude of the odds of SLEA. Results Among the 956 first-episode SLEA patients investigated, 78.8% were diagnosed with diabetes. Of these, 76.1% were male and 83.0% were aged 50 + years. Three comorbidities: renal failure (AOR = 1.9, 95% Cl 1.1 − 3.0), hypertension (AOR = 3.0, 95% Cl 2.0 − 4.5), and congestive heart failure (AOR = 2.0, 95% CI 1.2 − 3.2), conferred the highest odds of SLEA. The odds of SLEA is greatest for those aged 50–69 years, males, Registered Indians, and associated with a prolonged hospital stay. Discussion These data are important as they may help medical providers identify patients at the highest risk of SLEA and target interventions to optimize outcomes.

Patterns of inpatient acute care and emergency department utilization within one year post-initial amputation among individuals with dysvascular major lower extremity amputation in Ontario, Canada: A population-based retrospective cohort study

“…Recent research in the United States has shown that persons identifying as Black and living in rural settings are particularly at risk of a first dysvascular LEA [ 19 , 20 ] compared to those who were non-Black living in urban settings [ 20 ]. In Canada, recent research has shown Indigenous persons are at increased risk for subsequent LEA [ 21 ].…”