Perioperative and long-term all-cause mortality in patients with diabetes who underwent a lower extremity amputation

López-Valverde, María Eugenia; Aragón‐Sánchez, Javier; López‐de‐Andrés, Ana; Guerrero-Cedeño, Viviana; Tejedor-Méndez, Rebeca; Víquez-Molina, Gerardo; Jiménez-García, Rodrigo

doi:10.1016/j.diabres.2018.05.004

Cited by 36 publications

(29 citation statements)

References 23 publications

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“…The risks of diabetes-related amputation have previously been shown to be associated with male sex, ethnic group and deprivation [ 30 ], resulting in 5 year mortality rates as high as 34% [ 31 ]. We have previously compared diabetes-related amputation with non-diabetes-related amputation [ 32 ]: the median times to death were 27 and 47 months, respectively, and cardiac failure explained the main difference in outcomes.…”

Section: Discussionmentioning

confidence: 99%

Amputation-free survival in 17,353 people at high risk for foot ulceration in diabetes: a national observational study

et al. 2018

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Aims/hypothesisOur aim was to investigate amputation-free survival in people at high risk for foot ulceration in diabetes (‘high-risk foot’), and to compare different subcategories of high-risk foot.MethodsOverall, 17,353 people with diabetes and high-risk foot from January 2008 to December 2011 were identified from the Scotland-wide diabetes register (Scottish Care Information-Diabetes: N = 247,278). Participants were followed-up for up to 2 years from baseline and were categorised into three groups: (1) those with no previous ulcer, (2) those with an active ulcer or (3) those with a healed previous ulcer. Participants with prior minor or major amputation were excluded. Accelerated failure time models were used to compare amputation-free survival up to 2 years between the three exposure groups.ResultsThe 2 year amputation-free survival rate in all people with diabetes with high-risk foot was 84.5%. In this study group, 270 people (10.0%) had an amputation and 2424 (90.0%) died during the 2 year follow-up period. People who had active and healed previous ulcers at baseline had significantly lower 2 year amputation-free survival compared with those who had no previous ulcer (both p < 0.0001). The percentage of people who died within 2 years for those with healed ulcer, active ulcer or no baseline ulcer was 22.8%, 16% and 12.1%, respectively.Conclusions/interpretationIn people judged to be at high risk of foot ulceration, the risk of death was up to nine times the risk of amputation. Death rates were higher for people with diabetes who had healed ulcers than for those with active ulcers. However, people with active ulcers had the highest risk of amputation.Electronic supplementary materialThe online version of this article (10.1007/s00125-018-4723-y) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

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Section: Discussionmentioning

confidence: 99%

Amputation-free survival in 17,353 people at high risk for foot ulceration in diabetes: a national observational study

et al. 2018

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“…Reports suggest that DFU is a major warning sign for mortality, necessitating closer medical follow-ups. 4,5 Individuals with DFU are three times more likely to die compared to their non ulcerated peers.6 Despite the…”

Section: Introductionmentioning

confidence: 99%

Reduction in Diabetes-Related Major Amputation Rates After Implementation of a Multidisciplinary Model: An Evaluation in Alberta, Canada

Basiri

Haverstock

Petrasek

et al. 2021

Journal of the American Podiatric Medical Association

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BACKGROUND: Lower limb amputations (LLAs) are a major debilitating complication of diabetes. The toe and flow model (TFM) describes the framework for multidisciplinary centers aiming to reduce this complication. In this study, we investigate the efficacy of the TFM to reduce diabetes-related major LLAs in comparison with the standard of care (SOC) in the Canadian health care system. METHODS: We retrospectively reviewed the anonymized diabetes-related LLA reports in two similar metropolitan health zones in Alberta, Canada from 2007 to 2017. Although both zones have the same provincial health care system and similar demographics, Calgary, our first zone operates on the basis of the TFM while the Edmonton zone operates in accordance with the provincial SOC. LLAs were divided into minor and major amputation cohorts. We used the chi-square test, linear regression, and Pearson correlation for analysis. The lower proportion of major LLAs was denoted as a positive sign for the efficacy of the TFM. RESULTS: Although the number of LLAs remained relatively comparable (Calgary zone: 2238 and Edmonton zone: 2410), the Calgary zone had both significantly lower major (45%) and higher minor (42%) amputation incidence rates compared to the Edmonton zone. The increasing trend in minor LLAs and decreasing trend in major LLAs in the Calgary zone were negatively and significantly correlated (r = -0.730, p = 0.011). No significant correlation was found in the Edmonton zone. CONCLUSIONS: A significant reduction in the incidence rate, decreasing trend of diabetes-related major LLAs and the significant negative correlation of minor and major LLAs rates in the Calgary zone (TFM) compared to its sister zone Edmonton (SOC), provides supporting evidence for the impact of the TFM. This investigation provides support for a modernization of the diabetes-related limb preservation practice in Canada through the implementation of TFMs across the country to combat major LLAs.

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“…The impact of a major limb amputation is significant in both the acute and long-term settings, and effective post-operative incision management is a critical first step. In the acute post-operative period, amputation site healing can be complicated by surgical site infections (SSI) and wound dehiscence, each posing significant risks to patients and the healthcare system [2]. These complications may lead to prolonged hospitalization and/or readmission, which in turn may increase healthcare costs and apply stressors to patients and their support systems [3].…”

Section: Introductionmentioning

confidence: 99%

“…Incisional negative pressure wound therapy (iNPWT) has been well established in the literature as an effective adjunct for postoperative closed incision management and reduced SSI rates in patients at high risk for surgical site complications [2]. Patient comorbidities (e.g.…”

Section: Introductionmentioning

confidence: 99%

A Novel Use of Next-Generation Closed Incision Negative Pressure Wound Therapy After Major Limb Amputation and Amputation Revision

West

Wetherhold

Schulz

et al. 2020

Cureus

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Perioperative and long-term all-cause mortality in patients with diabetes who underwent a lower extremity amputation

Cited by 36 publications

References 23 publications

Amputation-free survival in 17,353 people at high risk for foot ulceration in diabetes: a national observational study

Amputation-free survival in 17,353 people at high risk for foot ulceration in diabetes: a national observational study

Reduction in Diabetes-Related Major Amputation Rates After Implementation of a Multidisciplinary Model: An Evaluation in Alberta, Canada

A Novel Use of Next-Generation Closed Incision Negative Pressure Wound Therapy After Major Limb Amputation and Amputation Revision

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