Diyabetik Majör Alt Ekstremite Ampütasyonu Uygulanan Hastalarda Revizyon Cerrahisinde Önemli Olan Faktörlerin Analizi

Öz

Amaç: Diyabetik ayak; ciddi morbidite, mortalite ve yüksek sosyoekonomik sorunlarla bağlantılı bir hastalıktır. Diyabetik ayaklarda yapılan revizyon ampütasyonlarına birçok risk faktörü etki etmektedir; ancak bu konuda literatürde görüş birliği bulunmamaktadır. Bu araştırmanın amacı, diyabetik major alt ekstremite ampütasyonu uygulanan hastalarda revizyon cerrahisini etkileyen önemli faktörlerin analizini yapmaktır. Gereç ve Yöntem: Retrospektif türdeki bu araştırma, İzmir ilinde bir üniversite hastanesinde 10.04.2023-12.10.2023 tarihleri arasında yürütülmüştür. Araştırmaya, 2010-2022 yılları arasında diyabetik ayak nedeniyle cerrahi operasyon geçiren toplam 276 hasta dahil edilmiştir. Hastaların demografik özellikleri ile revizyon cerrahisi üzerindeki etkisi araştırılan periferik anjiografi veya periferik bypass öyküsü, operasyonu gerçekleştiren cerrahi branş, başvuru ve taburcu sırasında kaydedilen hemoglobin, trombosit, Hemoglobin A1c, albümin, sedimentasyon, C-Reaktif Protein, sodyum, potasyum düzeyleri, lenfosit/nötrofil oranı, kan transfüzyon ihtiyacı ve Charlson Komorbidite İndeksi gibi parametreler değerlendirilerek veriler kaydedilmiştir. Bulgular: Hastalar revizyon ampütasyon yapılan (96), revizyon ampütasyon yapılmayan (180) grup olmak üzere iki gruba ayrılmıştır. Tüm hastalar arasında revizyon ampütasyon oranı %35 olarak belirlenmiştir. Revizyon ampütasyon riskini başvuru ve taburcu albümin düzeyi ile başvuru ve taburcu potasyum düzeyleri öngörebilmektedir. Yüksek başvuru albümin düzeyi ve düşük taburcu potasyum düzeyinin yanı sıra, yüksek başvuru potasyum düzeyi de revizyon cerrahisinin olumsuz sonuçlanmasına yol açabilmektedir. Sonuç: Yapılan bu araştırmada, birçok kaynakta yara iyileşmesi açısından önemli olduğu belirtilen albümin düzeyinin, sanılanın aksine, revizyon ampütasyon açısından belirleyici bir faktör olmadığı görülmüştür. Buna ek olarak, çeşitli metabolik hastalıklardan etkilenebilecek olan potasyum düzeyinin regülasyonu, ampütasyon sonrası zorunlu hale gelen revizyon cerrahisi üzerinde önemli bir etkiye sahip olabilir.

Anahtar Kelimeler

• Diyabetik ayak
• Majör alt ekstremite ampütasyonu
• Klinik parametreler
• Laboratuvar parametreleri

Analysis of Important Factors in Revision Surgery for Patients Undergoing Diabetic Major Lower Extremity Amputation

Öz

Aim: Diabetic foot is a disease associated with severe morbidity, mortality, and significant socioeconomic problems. Numerous risk factors influence revision amputations in diabetic feet; however, the literature does not reach a consensus on this matter. This study aims to analyze the significant factors affecting revision surgery in patients who have undergone major lower extremity amputations due to diabetes. Materials and Methods: This retrospective study was conducted at a university hospital in İzmir between April 10, 2023, and October 12, 2023. A total of 276 patients who underwent surgical operation due to diabetic foot between 2010 and 2022 were included in the study. The study evaluated the impact of demographic characteristics and various parameters, including a history of peripheral angiography or peripheral bypass, the surgical specialty performing the operation, hemoglobin, platelet count, hemoglobin A1c, albumin, sedimentation rate, C-reactive protein, sodium and potassium levels, lymphocyte-to-neutrophil ratio, blood transfusion requirements, and the Charlson Comorbidity Index, recorded at admission and discharge, on the need for revision surgery. Results: The patients were divided into two groups: those who underwent revision amputation (96) and those who did not (180). The revision amputation rate among all patients was determined to be 35%. The risk of revision amputation can be predicted by the admission and discharge albumin levels, as well as the admission and discharge potassium levels. In addition to high admission albumin levels and low discharge potassium levels, high admission potassium levels may also contribute to the adverse outcomes of revision surgery. Conclusions: In this study, it was found that albumin levels, which are considered important for wound healing in many sources, were not a determining factor for revision amputation as previously thought. Additionally, the regulation of potassium levels, which can be affected by various metabolic diseases, may have a significant impact on the revision surgery that becomes necessary after amputation.

Anahtar Kelimeler

• Diabetic foot
• Clinical parameters
• Laboratory parameters
• Major lower extremity amputation

Kaynakça

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