Re-amputation and survival following toe amputation: outcome data from a tertiary referral centre

Collins, Patrick; Joyce, Doireann; O’Beirn, Ellen; Elkady, Ramy; Boyle, Emily; Egan, Bridget; Tierney, Sean

doi:10.1007/s11845-021-02682-4

Cited by 2 publications

(1 citation statement)

References 20 publications

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“…In parallel with earlier literature reports which demonstrate approximately 60% of patients will need further LEA and 46% will have an DFU recurrence. 13,43,44 However, the mortality rate of approximately 9% was lower than the one reported in a recent systematic review (approximately 20%). 42 This positive finding can be justified by the diabetic foot management at our institution including a specialized service with a team approach to diabetic foot disease including podiatry.…”

Section: Discussionmentioning

confidence: 59%

Outcomes of Hallux Amputation Versus Partial First Ray Resection in People with Non-Healing Diabetic Foot Ulcers: A Pragmatic Observational Cohort Study

Blanchette

Houde

Armstrong

et al. 2022

The International Journal of Lower Extremity Wounds

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There are few data comparing outcomes after hallux amputation or partial first ray resection after diabetic foot ulcer (DFU). In a similar context, the choice to perform one of these two surgeries is attributable to clinician preference based on experience and characteristics of the patient and the DFU. Therefore, the purpose of this study was to determine the more definitive surgery between hallux amputation and partial first ray resection. We abstracted data from a cohort of 70 patients followed for a 1-year postoperative period to support clinical practice. We also attempted to identify patient characteristics leading to these outcomes. Our results suggested no statistical difference between the type of surgery and outcomes such as recurrence of DFU and amputation at 3, 6, and 12 months or death. However, there was a statistically significantly increased likelihood of re-ulceration for patients with CAD who underwent hallux amputation (p = 0.02). There was also a significantly increased likelihood of re-ulceration for people with depression or a history when the partial ray resection was performed (p = 0.02). Patients with prior amputation showed a higher probability of undergoing another re-amputation with partial ray resection (p = 0.01). Although the trends that emerge from this project are limited to what is observed in this statistical context, where the number of patients included and the number of total observations per outcome were limited, it highlights interesting data for future research to inform clinical decisions to support best practices for the benefit of patients.

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Section: Discussionmentioning

confidence: 59%

Outcomes of Hallux Amputation Versus Partial First Ray Resection in People with Non-Healing Diabetic Foot Ulcers: A Pragmatic Observational Cohort Study

Blanchette

Houde

Armstrong

et al. 2022

The International Journal of Lower Extremity Wounds

View full text Add to dashboard Cite

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Risk Factors for Unplanned Higher-Level Re-Amputation and Mortality after Lower Extremity Amputation in Chronic Limb-Threatening Ischemia

Guerra,

Guo,

Boyd

et al. 2024

JCM

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Background: The factors associated with unplanned higher-level re-amputation (UHRA) and one-year mortality among patients with chronic limb-threatening ischemia (CLTI) after lower extremity amputation are poorly understood. Methods: This was a single-center retrospective study of patients who underwent amputations for CLTI between 2014 and 2017. Unadjusted bivariate analyses and adjusted odds ratios (AOR) from logistic regression models were used to assess associations between pre-amputation risk factors and outcomes (UHRA and one-year mortality). Results: We obtained data on 203 amputations from 182 patients (median age 65 years [interquartile range (IQR) 57, 75]; 70.7% males), including 118 (58.1%) toe, 20 (9.9%) transmetatarsal (TMA), 37 (18.2%) below-knee (BKA), and 28 (13.8%) amputations at or above the knee. Median follow-up was 285 days (IQR 62, 1348). Thirty-six limbs (17.7%) had a UHRA, and the majority of these (72.2%) were following index forefoot amputations. Risk factors for UHRA included non-ambulatory status (AOR 6.74, 95% confidence interval (CI) 1.74–26.18; p < 0.10) and toe pressure < 30 mm Hg (AOR 4.89, 95% CI 1.52–15.78; p < 0.01). One-year mortality was 17.2% (n = 32), and risk factors included coronary artery disease (AOR 3.93, 95% CI 1.56–9.87; p < 0.05), congestive heart failure (AOR 4.90, 95% CI 1.96–12.29; p = 0.001), end-stage renal disease (AOR 7.54, 95% CI 3.10–18.34; p < 0.001), and non-independent ambulation (AOR 4.31, 95% CI 1.20–15.49; p = 0.03). Male sex was associated with a reduced odds of death at 1 year (AOR 0.37, 95% CI 0.15–0.89; p < 0.05). UHRA was not associated with one-year mortality. Conclusions: Rates of UHRA after toe amputations and TMA are high despite revascularization and one-year mortality is high among patients with CLTI requiring amputation.

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Re-amputation and survival following toe amputation: outcome data from a tertiary referral centre

Cited by 2 publications

References 20 publications

Outcomes of Hallux Amputation Versus Partial First Ray Resection in People with Non-Healing Diabetic Foot Ulcers: A Pragmatic Observational Cohort Study

Outcomes of Hallux Amputation Versus Partial First Ray Resection in People with Non-Healing Diabetic Foot Ulcers: A Pragmatic Observational Cohort Study

Risk Factors for Unplanned Higher-Level Re-Amputation and Mortality after Lower Extremity Amputation in Chronic Limb-Threatening Ischemia

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