Incidence, Risk Factors, and Causes for Thirty-Day Unplanned Readmissions Following Primary Lower-Extremity Amputation in Patients with Diabetes

Ries, Zachary; Rungprai, Chamnanni; Harpole, Bethany; Phruetthiphat, Ong-art; Gao, Yubo; Pugely, Andrew J.; Phisitkul, Phinit

doi:10.2106/jbjs.o.00449

Cited by 32 publications

(15 citation statements)

References 24 publications

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“…Several studies have investigated the efficacy of disease duration, regulation of blood glucose level, HbA1c level, blood levels of BUN, CRP, and ESR, BMI, additional comorbid diseases (renal insufficiency, congestive heath failure, and hypertension), smoking, sex, and age on estimating the progression of ulcer lesions in the feet of diabetic patients. 22 , 23 , 24 , 25 , 26 In the present study, indicators such as ESR and CRP had no significant effect on mortality.…”

Section: Discussioncontrasting

confidence: 48%

Factors affecting lifespan following below-knee amputation in diabetic patients

Beyaz¹,

Güler²,

Bağır³

2017

Acta Orthopaedica et Traumatologica Turcica

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IntroductionUntreatable foot problems in diabetics may require lower extremity amputation, which has a high level of patient mortality. This high mortality rate is worse than most malignancies. The present study aimed to identify parameters that can be used to estimate survival in DM patients undergoing below-knee amputations for diabetic foot problems.Materials and methodsA total of 470 patients (299 males, 171 females) with a mean age of 64.32 years who underwent below-knee amputation for diabetic foot problems between 2004 and 2014 were enrolled in the study. The length of time from the operation to time of death was recorded in days. Patient details were obtained, including age during surgery, BMI, oral antidiabetic and insulin usage, dialysis therapy history, lower extremity endovascular intervention, previous amputation at the same extremity, the need for stump revision surgery during follow-up, and above-knee amputation at the same site. Biochemical test results of pre-operative HbA1c, ESR, and levels of CRP, BUN, and creatinine were also obtained.ResultsA total of 333 patients (70.9%) died and 137 (29.1%) survived post-surgery. Survival rates were 90% in the first 7 days, 84% in the first 30 days, and 64% after the first year. Patient median life expectancy post-surgery was 930 ± 106 days. Hemodialysis treatment (p = 0.001), endovascular intervention (p = 0.04), sex (p = 0.004), age (p = 0.001), BUN level (p = 0.001), and duration of insulin use (p = 0.003) were shown to be effective predictors of mortality.ConclusionsLife expectancy is low (<3 years) in DM patients requiring below-knee amputations for untreatable foot problems. Survival could be predicted by duration of insulin use, age, sex, and renal insufficiency.Level of evidenceLevel IV, Therapeutic study.

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Section: Discussioncontrasting

confidence: 48%

Factors affecting lifespan following below-knee amputation in diabetic patients

Beyaz¹,

Güler²,

Bağır³

2017

Acta Orthopaedica et Traumatologica Turcica

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“…Unlike studies that report readmission rates of 26.3% for patients who have undergone major lower extremity amputations, 34,35 the 30-day re-admission rate for our cohort was only 13.3% (Supplemental Fig. 1).…”

Section: Discussioncontrasting

confidence: 83%

Amputation stump perfusion is predictive of post-operative necrotic eschar formation

Silva

Saffaf

Sánchez

et al. 2018

The American Journal of Surgery

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“…Because diabetes and ESRD are themselves independent risk factors for postoperative complications, the postoperative complication rate following LEA in these patients is substantial. In our study, the rates of overall complications, major complications, and mortality were 35%, 24%, and 9%, respectively; these values are relatively high compared to those for other causes of LEA . Therefore, to prevent this high complication rate, it is essential to identify the preoperative risk factors of LEA in patients with diabetic ESRD.…”

Section: Discussionmentioning

confidence: 60%

“…In our study, the rates of overall complications, major complications, and mortality were 35%, 24%, and 9%, respectively; these values are relatively high compared to those for other causes of LEA. 11,16 Therefore, to prevent this high complication rate, it is essential to identify the preoperative risk factors of LEA in patients with diabetic ESRD.…”

Section: Discussionmentioning

confidence: 99%

Predictors of complication following lower extremity amputation in diabetic end‐stage renal disease

Park

Song

Choi³

2018

Nephrology

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Incidence, Risk Factors, and Causes for Thirty-Day Unplanned Readmissions Following Primary Lower-Extremity Amputation in Patients with Diabetes

Abstract: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 32 publications

References 24 publications

Factors affecting lifespan following below-knee amputation in diabetic patients

Factors affecting lifespan following below-knee amputation in diabetic patients

Amputation stump perfusion is predictive of post-operative necrotic eschar formation

Predictors of complication following lower extremity amputation in diabetic end‐stage renal disease

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