Minor vs. major leg amputation in adults with diabetes: Six-month readmissions, reamputations, and complications

Ratliff, Hunter T.; Shibuya, Naohiro; Jupiter, Daniel C.

doi:10.1016/j.jdiacomp.2021.107886

Cited by 16 publications

(6 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Parallel to our results, PLT was found to be a predictive factor in many cohorts. 18 , 26 Patients with amputation had increased PLT counts over nonamputee DFU patients in a Chinese tertiary care hospital. 27 Some factors, such as elevated HDL and HGB levels, seem to be protective against the risk of amputation.…”

Section: Discussionmentioning

confidence: 95%

Analysis of risk factors for amputation in patients with diabetic foot ulcers: a cohort study from a tertiary center

Demirkol¹,

Aktaş²,

Özcan³

et al. 2022

AOTT

View full text Add to dashboard Cite

Objective: This study aimed to analyze risk factors for amputation (overall, minor and major) in patients with diabetic foot ulcers (DFUs). Methods: 407 patients with DFUs (286 male, 121 female; mean age = 60, age range = 32-92) who were managed in a tertiary care centre from 2009 to 2019 were retrospectively identified and included in the study. DFUs were categorized based on the Meggit-Wagner, PEDIS, S(AD)SAD, and University of Texas (UT) classification systems. To identify amputation risk-related factors, results of patients with DFUs who underwent amputations (minor or major) were compared to those who received other adjunctive treatments using Chi-Square, one-way analysis of variance (ANOVA) and Spearman correlation analysis. Results: The mean C-reactive protein (CRP) and White Blood Cell (WBC) values were significantly higher in patients with major or minor amputation than in those without amputation. The mean Neutrophil (PNL), Platelets (PLT), wound width, creatinine and sedimentation (ESR) values were significantly higher in patients with major amputation compared to other groups of patients. Elevated levels of High-density lipoprotein (HDL), Hemoglobin (HGB) and albumin were determined to be protective factors against the risk of amputation. Spearman correlation analysis revealed a positive-sided, strong-levelled, significant relation between Wagner grades and amputation status of patients. Conclusion: This study has identified specific factors for major and minor amputation risk of patients with DFUs. Especially infection markers such as CRP, WBC, ESR and PNL were higher in the amputation group. Most importantly, Meggit Wagner, one of the four different classification systems used in the DFUs, was determined to be highly associated with patients’ amputation risk. Level of Evidence: Level IV, Prognostic Study

show abstract

Section: Discussionmentioning

confidence: 95%

Analysis of risk factors for amputation in patients with diabetic foot ulcers: a cohort study from a tertiary center

Demirkol¹,

Aktaş²,

Özcan³

et al. 2022

AOTT

View full text Add to dashboard Cite

show abstract

“…The US minor and major amputation IRs were, therefore, generally higher than those in the present study. Given the recurrent and relapsing natural history of diabetes-related foot ulcers (DFU) and the relatively high rates of re-operation after minor LEA, 27 , 28 it is plausible that first incident minor LEAs may be declining as shown in the FDS data but that those requiring a minor LEA are at increasing risk of subsequent repeat minor surgical procedures rather than progression to a major LEA, as shown in the US dataset. Alternatively, the increasing incidence of diabetes and its complications including LEA at a relatively young age that has been seen in the US 14 , 15 has not yet had the same impact on minor LEA IRs in Australia.…”

Section: Discussionmentioning

confidence: 99%

Temporal trends in minor and major lower extremity amputation in people with type 2 diabetes: The Fremantle Diabetes Study

Hamilton

Davis

Baba

et al. 2023

Diabetes and Vascular Disease Research

View full text Add to dashboard Cite

Aims To determine whether incident minor and major lower extremity amputations (LEAs) have declined in recent decades in type 2 diabetes. Methods Participants with type 2 diabetes from the community-based Fremantle Diabetes Study Phases I (FDS1; n = 1,296, mean age 64.0 years, recruited 1993–1996) and II (FDS2; n = 1,509, mean age 65.4 years, recruited 2008–2011) were followed from entry to incident minor/major LEA, death or five years. Cox regression determined hazard ratios (HRs) for each outcome for FDS2 versus FDS1 and independent predictors of incident minor and major LEA in the combined cohort. Results Age- and sex-adjusted HRs (95% CIs) in FDS2 versus FDS1 for incident minor and major LEA were, respectively, 0.60 (0.27, 1.35) and 0.59 (0.22, 1.59). Higher glycated haemoglobin, urine albumin: creatinine (uACR) ratio and peripheral sensory neuropathy (PSN) were independent predictors of incident minor LEA. Higher fasting serum glucose, peripheral arterial disease (PAD), end-stage kidney disease and prior diabetes-related minor LEA were associated with incident major LEA. Conclusions There were non-significant reductions of approximately 40% in incident minor and major LEA in community-based people with type 2 diabetes during the 15 years between FDS Phases. Predictors of minor/major LEA confirm distinct high-risk patient groups with implications for clinical management.

show abstract

“…Major amputations were defined as amputations occurring during index admission above the level of the ankle joint. 21 Minor amputations were considered at or below this level. MACE was defined as instances of ST‐segment elevation myocardial infarction, non–ST‐segment elevation myocardial infarction, or ischemic stroke during index admission.…”

Section: Methodsmentioning

confidence: 99%

Examining Outcomes in Patients Admitted With Comorbid Peripheral Artery Disease and Microvascular Disease

Grubman,

Algara,

Smolderen

et al. 2024

JAHA

View full text Add to dashboard Cite

Background Peripheral artery disease (PAD) and microvascular disease (MVD) are highly prevalent conditions that share common risk factors. This observational study aimed to characterize patients with both conditions and determine the impact of comorbid PAD/MVD on outcomes. Methods and Results Patients admitted across 31 states January 2011 through December 2018 with a primary or secondary diagnosis of PAD or MVD were included from the National Readmissions Database and weighted to approximate a national sample. Those age <18 years or with nonatherosclerotic leg injuries were excluded. Patients were divided into 3 groups: PAD‐only, MVD‐only, or comorbid PAD/MVD. Multiple logistic regression was used to evaluate associations with major and minor amputations, major adverse cardiac events, and in‐hospital mortality. Cox regression was used to evaluate associations with readmission within 1 year. The PAD group was used as reference. The final cohort included 33 972 772 admissions: 9.1 million with PAD, 21.3 million with MVD, and 3.6 million with both. Annual admissions for PAD/MVD increased to >500 000 in 2018. Major and minor amputations increased ≈50% for PAD/MVD between 2011 and 2018. Compared with PAD‐only, PAD/MVD was associated with a higher risk for major amputation (odds ratio [OR], 1.30 [95% CI, 1.28–1.32]), minor amputation (OR, 2.15 [95% CI, 2.12–2.18]), major adverse cardiac events (OR, 1.04 [95% CI, 1.03–1.04]), in‐hospital mortality (OR, 1.07 [95% CI, 1.05–1.09]), and readmission (hazard ratio, 1.02 [95% CI, 1.02–1.02]) after adjustment for baseline factors. Conclusions Comorbid MVD is present in a large and growing number of patients with PAD and is associated with augmented risk for adverse outcomes. Further prospective research is merited to understand this vulnerable population.

show abstract

Minor vs. major leg amputation in adults with diabetes: Six-month readmissions, reamputations, and complications

Cited by 16 publications

References 33 publications

Analysis of risk factors for amputation in patients with diabetic foot ulcers: a cohort study from a tertiary center

Analysis of risk factors for amputation in patients with diabetic foot ulcers: a cohort study from a tertiary center

Temporal trends in minor and major lower extremity amputation in people with type 2 diabetes: The Fremantle Diabetes Study

Examining Outcomes in Patients Admitted With Comorbid Peripheral Artery Disease and Microvascular Disease

Contact Info

Product

Resources

About