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Factors Affecting Amputations in Patients with Diabetic Foot Ulcer Referring To the Emergency Units

Year 2017, Volume: 44 Issue: 1, 91 - 98, 17.03.2017
https://doi.org/10.5798/dicletip.298615

Abstract

Objective: Diabetic foot is the most common cause of lower extremity amputations. The aim of the present study was to investigate the clinical characteristics of and factors affecting amputation in patients with diabetic foot ulcer referring to the emergency units.
Methods: The present study was performed based on retrospective review of medical files of 58 patients who were referred to the Emergency Unit of Dicle University, Faculty of Medicine between June 2010 and October 2016 due to diabetic foot ulcer.
Results: Of 58 patients included in this study, 31 (53.4%) were men and 27 (46.6%) were women. The mean age was 61.43±11.584 (range: 41 to 85) years. Extremity amputation was not performed in 34 patients (58.6%), while 24 (41.4%) underwent an amputation. Factors affecting extremity amputation were found to be disease duration, presence of coronary artery disease, duration of hospital stay, and presence of osteomyelitis. Among laboratory findings, factors affecting extremity amputation were albumin, hemoglobin, leukocytes, neutrophil, neutrophil/lymphocyte ratio, hemoglobin A1c, and elevated erythrocyte sedimentation rate. The Wagner-Meggitt Classification of Grade 4, University of Texas Classification of stage D and Grade 3 also had significant effects on amputation. (p<0.05)
Conclusion: Our study results suggest that together with classification systems, comorbidities, albumin levels, hemoglobin A1c levels, sedimentation rate, and complete blood count results play a key role in predicting the amputation requirement in patients with diabetic foot ulcers referring to the emergency units.

References

  • 1. Hingorani A, LaMuraglia GM, Henke P, et al. The management of diabetic foot: A clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine. J Vasc Surg. 2016; 63:3-21.
  • 2. Janet LK, Irl BH. Medical management of patients with Diabetes during perioperative period. In: Bowker JH, Pfeifer MA, eds, Levin and O’Neal’s The Diabetic Foot. 7th edition. Philadelphia: Mosby. 2008; 387-401.
  • 3. David GA, Lavery LA, Harkless LB. Treatment based classification system for assessment and care of diabetic feet. J Am Pod Med Assoc. 1996; 86:311-6.
  • 4. Boulton AJ, Armstrong DG, Albert SF, et al. Comprehensive foot examination and risk assessment: a report of the task force of the foot care interest group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care 2008; 31:1679.
  • 5. Armstrong DG, Lipsky BA. Diabetic foot infections: stepwise medical and surgical management. Int Wound J 2004; 1:123-32.
  • 6. Jain AKC. A new classıfıcatıon of dıabetıc foot complıcatıons: a sımple and effectıve teachıng tool. The Journal of Diabetic Foot Complications. 2012; 4:1-5.
  • 7. Robbins JM, Strauss G, Aron D, et al. Mortality Rates and Diabetic Foot Ulcers. J Am Podiatr Med Assoc 2008; 98:489-93.
  • 8. Cavanagh P, Attinger C, Abbas Z, et al. Diabetes Metab Res Rev 2012; 28:107-111.
  • 9. Yesil S, Akinci B, Yener S, et al. Predictors of amputation in diabetics with foot ulcer: single center experience in a large Turkish cohort. Hormones (Athens) 2009; 8:286-95.
  • 10. Pscherer S, Dippel FW, Lauterbach S, Kostev K. Amputation rate and risk factors in type 2 patients with diabetic foot syndrome under real-life conditions in Germany. Prim Care Diabetes 2012; 6:241-6.
  • 11. Ashraf MN, Khalil-ur-Rehman, Malik KI, Iqbal GS. Epidemiology and outcome in patients of diabetic foot. J Ayub Med Coll Abbottabad 2011; 23:122-4.
  • 12. Skrepnek GH, Mills JL Sr, Armstrong DG. A Diabetic Emergency One Million Feet Long: Disparities and Burdens of Illness among Diabetic Foot Ulcer Cases within Emergency Departments in the United States, 2006–2010. PLoS ONE 2015; 10:1-15.
  • 13. Demirci H, Aktürk M, Karakoç A, et al. Diyabetik ayak ülserli hastalarda mikrovasküler komplikasyonların sıklığı ve osteomiyelit ile ilişkisi. Gazi Medical Journal 2006; 17:209-12.
  • 14. Setacci C, Sirignano P, Mazzitelli G, et al. Diabetic Foot: Surgical Approach in Emergency. Int J Vasc Med. 2013; 2013:296169.
  • 15. Durgun O, Durgun AG, Ersoy CÖ, ve ark. Diyabetik Ayak Gelişmiş Olgularda Amputasyon Gerekliliğini Belirleyen Faktörlerin Retrospektif Olarak İncelenmesi. Uludağ Üniversitesi Tıp Fakültesi Dergisi 2012; 38:59-62.
  • 16. Namgoong S, Jung S, Han SK, Jeong SH, Dhong ES, Kim WK. Risk factors for major amputation in hospitalised diabetic foot patients. Int Wound J 2016; 13:13-19.
  • 17. Jeon B-J, Choi HJ, Kang JS, et al. Comparison of five systems of classification of diabetic foot ulcers and predictive factors for amputation. Int Wound J 2016; doi: 10.1111/iwj.12642.
  • 18. Beaney AJ, Nunney I, Gooday C, Dhatariya K. Factors determining the risk of diabetes foot amputations--A retrospective analysis of a tertiary diabetes foot care service. Diabetes Res Clin Pract. 2016; 114:69-74.
  • 19. Pemayun TG, Naibaho RM, Novitasari D, et al. Risk factors for lower extremity amputation in patients with diabetic foot ulcers: a hospital-based case-control study. Diabet Foot Ankle. 2015; 6:29629.
  • 20. Wukich DK, Hobizal KB, Sambenedetto TL, et al. Outcomes of Osteomyelitis in Patients Hospitalized With Diabetic Foot Infections. Foot Ankle Int. 2016; Aug 22. pii: 1071100716664364.
  • 21. Zhou ZY, Liu YK, Chen HL, et al. HbA1c and Lower Extremity Amputation Risk in Patients With Diabetes: A Meta-Analysis. Int J Low Extrem Wounds. 2015; 14:168-77.
  • 22. Monteiro-Soares M, Martins-Mendes D, Vaz-Carneiro A, et al. Classification systems for lower extremity amputation prediction in subjects with active diabetic foot ulcer: a systematic review and meta-analysis. Diabetes Metab Res Rev 2014; 30:610–22.
Year 2017, Volume: 44 Issue: 1, 91 - 98, 17.03.2017
https://doi.org/10.5798/dicletip.298615

Abstract

References

  • 1. Hingorani A, LaMuraglia GM, Henke P, et al. The management of diabetic foot: A clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine. J Vasc Surg. 2016; 63:3-21.
  • 2. Janet LK, Irl BH. Medical management of patients with Diabetes during perioperative period. In: Bowker JH, Pfeifer MA, eds, Levin and O’Neal’s The Diabetic Foot. 7th edition. Philadelphia: Mosby. 2008; 387-401.
  • 3. David GA, Lavery LA, Harkless LB. Treatment based classification system for assessment and care of diabetic feet. J Am Pod Med Assoc. 1996; 86:311-6.
  • 4. Boulton AJ, Armstrong DG, Albert SF, et al. Comprehensive foot examination and risk assessment: a report of the task force of the foot care interest group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care 2008; 31:1679.
  • 5. Armstrong DG, Lipsky BA. Diabetic foot infections: stepwise medical and surgical management. Int Wound J 2004; 1:123-32.
  • 6. Jain AKC. A new classıfıcatıon of dıabetıc foot complıcatıons: a sımple and effectıve teachıng tool. The Journal of Diabetic Foot Complications. 2012; 4:1-5.
  • 7. Robbins JM, Strauss G, Aron D, et al. Mortality Rates and Diabetic Foot Ulcers. J Am Podiatr Med Assoc 2008; 98:489-93.
  • 8. Cavanagh P, Attinger C, Abbas Z, et al. Diabetes Metab Res Rev 2012; 28:107-111.
  • 9. Yesil S, Akinci B, Yener S, et al. Predictors of amputation in diabetics with foot ulcer: single center experience in a large Turkish cohort. Hormones (Athens) 2009; 8:286-95.
  • 10. Pscherer S, Dippel FW, Lauterbach S, Kostev K. Amputation rate and risk factors in type 2 patients with diabetic foot syndrome under real-life conditions in Germany. Prim Care Diabetes 2012; 6:241-6.
  • 11. Ashraf MN, Khalil-ur-Rehman, Malik KI, Iqbal GS. Epidemiology and outcome in patients of diabetic foot. J Ayub Med Coll Abbottabad 2011; 23:122-4.
  • 12. Skrepnek GH, Mills JL Sr, Armstrong DG. A Diabetic Emergency One Million Feet Long: Disparities and Burdens of Illness among Diabetic Foot Ulcer Cases within Emergency Departments in the United States, 2006–2010. PLoS ONE 2015; 10:1-15.
  • 13. Demirci H, Aktürk M, Karakoç A, et al. Diyabetik ayak ülserli hastalarda mikrovasküler komplikasyonların sıklığı ve osteomiyelit ile ilişkisi. Gazi Medical Journal 2006; 17:209-12.
  • 14. Setacci C, Sirignano P, Mazzitelli G, et al. Diabetic Foot: Surgical Approach in Emergency. Int J Vasc Med. 2013; 2013:296169.
  • 15. Durgun O, Durgun AG, Ersoy CÖ, ve ark. Diyabetik Ayak Gelişmiş Olgularda Amputasyon Gerekliliğini Belirleyen Faktörlerin Retrospektif Olarak İncelenmesi. Uludağ Üniversitesi Tıp Fakültesi Dergisi 2012; 38:59-62.
  • 16. Namgoong S, Jung S, Han SK, Jeong SH, Dhong ES, Kim WK. Risk factors for major amputation in hospitalised diabetic foot patients. Int Wound J 2016; 13:13-19.
  • 17. Jeon B-J, Choi HJ, Kang JS, et al. Comparison of five systems of classification of diabetic foot ulcers and predictive factors for amputation. Int Wound J 2016; doi: 10.1111/iwj.12642.
  • 18. Beaney AJ, Nunney I, Gooday C, Dhatariya K. Factors determining the risk of diabetes foot amputations--A retrospective analysis of a tertiary diabetes foot care service. Diabetes Res Clin Pract. 2016; 114:69-74.
  • 19. Pemayun TG, Naibaho RM, Novitasari D, et al. Risk factors for lower extremity amputation in patients with diabetic foot ulcers: a hospital-based case-control study. Diabet Foot Ankle. 2015; 6:29629.
  • 20. Wukich DK, Hobizal KB, Sambenedetto TL, et al. Outcomes of Osteomyelitis in Patients Hospitalized With Diabetic Foot Infections. Foot Ankle Int. 2016; Aug 22. pii: 1071100716664364.
  • 21. Zhou ZY, Liu YK, Chen HL, et al. HbA1c and Lower Extremity Amputation Risk in Patients With Diabetes: A Meta-Analysis. Int J Low Extrem Wounds. 2015; 14:168-77.
  • 22. Monteiro-Soares M, Martins-Mendes D, Vaz-Carneiro A, et al. Classification systems for lower extremity amputation prediction in subjects with active diabetic foot ulcer: a systematic review and meta-analysis. Diabetes Metab Res Rev 2014; 30:610–22.
There are 22 citations in total.

Details

Subjects Health Care Administration
Journal Section Research Articles
Authors

Mustafa İçer This is me

Hasan Mansur Durgun This is me

Publication Date March 17, 2017
Submission Date March 17, 2017
Published in Issue Year 2017 Volume: 44 Issue: 1

Cite

APA İçer, M., & Durgun, H. M. (2017). Factors Affecting Amputations in Patients with Diabetic Foot Ulcer Referring To the Emergency Units. Dicle Tıp Dergisi, 44(1), 91-98. https://doi.org/10.5798/dicletip.298615
AMA İçer M, Durgun HM. Factors Affecting Amputations in Patients with Diabetic Foot Ulcer Referring To the Emergency Units. diclemedj. March 2017;44(1):91-98. doi:10.5798/dicletip.298615
Chicago İçer, Mustafa, and Hasan Mansur Durgun. “Factors Affecting Amputations in Patients With Diabetic Foot Ulcer Referring To the Emergency Units”. Dicle Tıp Dergisi 44, no. 1 (March 2017): 91-98. https://doi.org/10.5798/dicletip.298615.
EndNote İçer M, Durgun HM (March 1, 2017) Factors Affecting Amputations in Patients with Diabetic Foot Ulcer Referring To the Emergency Units. Dicle Tıp Dergisi 44 1 91–98.
IEEE M. İçer and H. M. Durgun, “Factors Affecting Amputations in Patients with Diabetic Foot Ulcer Referring To the Emergency Units”, diclemedj, vol. 44, no. 1, pp. 91–98, 2017, doi: 10.5798/dicletip.298615.
ISNAD İçer, Mustafa - Durgun, Hasan Mansur. “Factors Affecting Amputations in Patients With Diabetic Foot Ulcer Referring To the Emergency Units”. Dicle Tıp Dergisi 44/1 (March 2017), 91-98. https://doi.org/10.5798/dicletip.298615.
JAMA İçer M, Durgun HM. Factors Affecting Amputations in Patients with Diabetic Foot Ulcer Referring To the Emergency Units. diclemedj. 2017;44:91–98.
MLA İçer, Mustafa and Hasan Mansur Durgun. “Factors Affecting Amputations in Patients With Diabetic Foot Ulcer Referring To the Emergency Units”. Dicle Tıp Dergisi, vol. 44, no. 1, 2017, pp. 91-98, doi:10.5798/dicletip.298615.
Vancouver İçer M, Durgun HM. Factors Affecting Amputations in Patients with Diabetic Foot Ulcer Referring To the Emergency Units. diclemedj. 2017;44(1):91-8.