Does re-amputation following lower extremity amputation in diabetic or dysvascular patients negatively affect survival?

Yıl 2022, Cilt: 35 Sayı: 1, 73 - 78, 31.01.2022

Ozgur Baysal Waziri Juma Msangı Berkin Günar Bulent Erol

https://doi.org/10.5472/marumj.1059068

Cited By: 1

Öz

Objective: We aimed to investigate the characteristics of patients who underwent unilateral amputation due to diabetes and peripheral artery disease, as well as the risk factors that cause re-amputation, and to determine these patients' survival status and the risk factors for mortality.
Patients and Methods: This retrospective study included 133 patients who underwent amputation due to diabetes and peripheral arterial disease between 2012 and 2018. The etiology of amputation, the re-operation rate and time to re-operation following initial amputation, survival status and follow up results were accessed from hospital records.
Results: Twenty-eight patients underwent amputation due to peripheral arterial disease, whereas 105 patients had peripheral vasculopathy due to diabetes mellitus. The re-operation rate was 33.8%, and the median period from initial surgery to the second surgery was six-weeks. Sixty-six deceased patients survived with a median of 6 months following initial operation.
Conclusion: The most crucial factor causing re-amputation was the non-healing wound problems. Patients with amputation should be followed up carefully for wound problems in the six weeks after surgery. Advanced age, American Society of Anesthesiologist grade 4 patients, associating neurological disease, low albumin level, low lymphocyte count and postoperative intensive care unit requirement were all poor prognostic factors for survival. Re-amputation had no negative effect on survival.

Anahtar Kelimeler

Amputation, Diabetes mellitus, Lower extremity, Reoperation rate, Mortality, Peripheral arterial disease

Kaynakça

• Giurato L, Meloni M, Izzo V, Uccioli L. Osteomyelitis in diabetic foot: A comprehensive overview. World J Diabetes 2017;8:135-42. doi. 10.4239/wjd.v8.i4.135.
• Frykberg RG, Banks J. Challenges in the treatment of chronic wounds. Adv Wound Care (New Rochelle) 2015;4:560-82. doi: 10.1089/wound.2015.0635.
• Ceyhan Ö, Akutay S. Diyabetik hastalarda amputasyon sonrası yara iyileşmesi ve bakım. Sakarya Tıp Dergisi 2019;9:11-5. doi:10.31832/smj.496098
• 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;31:1679-85. doi: 10.2337/dc08-9021
• Alavi A, Sibbald RG, Mayer D, et al. Diabetic foot ulcers: Part I. Pathophysiology and prevention. J Am Acad Dermatol 2014;70:1.e-18; quiz 9-20. doi: 10.1016/j.jaad.2013.06.055
• Armstrong DG, Boulton AJM, Bus SA. Diabetic foot ulcers and their recurrence. N Engl J Med 2017;376:2367-75. doi:10.1056/nejmra1615439.
• Varma P, Stineman MG, Dillingham TR. Epidemiology of limb loss. Phys Med Rehabil Clin N Am 2014;25:1-8. doi:10.1016/j.pmr.2013.09.001.
• Olgun N EAF, Çoşansu G, Çelik S. Diabetes mellitus. İçinde: Dahili ve Cerrahi Hastalıklarda Bakım. 4th ed. Ankara: Akademisyen Kitabevi, 2017:787-824.
• Konya P, Demirtürk N. Son üç yılda kliniğimizde izlenen diyabetik Ayak infeksiyonlarının değerlendirilmesi. Acta Medica Alanya 2017;1:11-4. doi:10.30565/medalanya.261700
• O'Brien PJ, Cox MW, Shortell CK, Scarborough JE. Risk factors for early failure of surgical amputations: an analysis of 8,878 isolated lower extremity amputation procedures. J Am Coll Surg 2013;216:836-42. doi: 10.1016/j.jamcollsurg.2012.12.041
• Kılıç B, Yücel AS, Yaman Ç, Hergüner G, Korkmaz M. Methods of determining the amputation level of lower extremity.EuroJ ExpBio 2014;4:55-60.
• van Schaik L, Geertzen JHB, Dijkstra PU, Dekker R. Metabolic costs of activities of daily living in persons with a lower limb amputation: A systematic review and meta-analysis. PLoS One 2019;14:e0213256. doi: 10.1371/journal.pone.0213256.
• Baumfeld D, Baumfeld T, Macedo B, Zambelli R, Lopes F, Nery C. Factors related to amputation level and wound healing in diabetic patients. Acta Ortop Bras 2018;26:342-5. doi:10.1590/1413-785220182605173445
• Berlin MC, Wanivenhaus F, Kabelitz M, et al. Predictors for reoperation after lower limb amputation in patients with peripheral arterial disease. Vasa 2019;48:419-24. doi: 10.1024/0301-1526/a000796.
• Horgan O, MacLachlan M. Psychosocial adjustment to lower-limb amputation: a review. Disabil Rehabil 2004;26:837-50. doi: 10.1080/09638280410001708869.
• Gülcü A, Eli M, Karahan O, Aslan A. Analysis of routine blood markers for predicting amputation/reamputation risk in diabetic foot. Int Wound J 2020;17:1996-2004. doi:10.1111/iwj.13491
• Wanivenhaus F, Mauler F, Stelzer T, Tschopp A, Böni T, Berli MC. Revision rate and risk factors after lower extremity amputation in diabetic or dysvascular patients. Orthopedics 2016;39:e149-54. doi:10.3928/01477447-20151222-14
• 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 Suppl 1:13-9.doi: 10.1111/iwj.12526.
• 19. Akan KH. Diyabetik ayakta ampütasyon.TOTBİD Dergisi2105; 14 , 421-32. doi:10.14292/totbid.dergisi.2015.62
• Akçay S, Harman E, Satoğlu İS, Kurtulmuş A. Diyabetik ayak amputasyonlarında reamputasyon oranları [Rates and risk factors of diabetic foot reamputations]. Flora 2018; 23 , 202-7. doi: 10.5578/flora.67491
• Czerniecki JM, Thompson ML, Littman AJ, et al. Predicting reamputation risk in patients undergoing lower extremity amputation due to the complications of peripheral artery disease and/or diabetes. Br J Surg 2019;106:1026-34. doi: 10.1002/bjs.11160.
• Monge L, Gnavi R, Carnà P, Broglio F, Boffano GM, Giorda CB. Incidence of hospitalization and mortality in patients with diabetic foot regardless of amputation: a population study. Acta Diabetologia 2020;57:221-8. doi: 10.1007/s00592-019-01412-8.
• Hartemann-Heurtier A, Robert J, Jacqueminet S, et al. Diabetic foot ulcer and multidrug-resistant organisms: risk factors and impact. Diabet Med 2004;21:710-5. doi: 10.1111/j.1464-5491.2004.01237.x.
• Stern JR, Wong CK, Yerovinkina M, et al. A meta-analysis of long-term mortality and associated risk factors following lower extremity amputation. Ann Vasc Surg. 2017;42:322-7. doi:10.1016/j.avsg.2016.12.015.