Risk factors for reamputation in patients with diabetic foot: A case-control study

Background: Reamputation as a complication of diabetic foot ulcers presents a high economic burden and represents a therapeutic failure. It is paramount to identify as early as possible patients in whom a minor amputation may not be the best option. The purpose of this investigation was to do a case-controlled study to determine risk factors associated with re-amputation in patients with DFU (diabetic foot ulcers) at two University Hospitals. Methods: Multicentric, observational, retrospective, case-control study from clinical records of 2 university hospitals. Our study included 420 patients, with 171 cases (re-amputations), and 249 controls. We performed a multivariate logistic regression analysis and time-to-event survival analysis to identify re-amputation risk factors. Results: Statistically significant risk factors were artery history of tobacco use (p = 0.001); male sex (p = 0.048); arterial occlusion in Doppler ultrasound (p = 0.001); percentage of stenosis in arterial ultrasound >50 % (p = 0.053); requirement of vascular intervention (p = 0.01); and microvascular involvement in photoplethysmography (p = 0.033). The most parsimonious regression model suggests that history of tobacco use, male sex, arterial occlusion in ultrasound, and percentage of stenosis in arterial ultrasound >50 % remained statistically significant. The survival analysis identified earlier amputations in patients with larger occlusion in arterial ultrasound, high leukocyte count, and elevated ESR. Conclusion: Direct and surrogate outcomes in patients with diabetic foot ulcers identify vascular involvement as an important risk factor for reamputation.

• Autores: Correa Sánchez, Carlos Alberto; Vargas-Hernández, Juan Sebastián; García, Luisa Fernanda; Jaimes, Julián; Caicedo, Martha; Niño, Manuel Eduardo; Robledo Quijano, Jaime
• Tipo de recurso: https://purl.org/coar/resource_type/c_6501
• Fecha de publicación: 2023
• Institución: Universidad El Bosque
• Repositorio: Repositorio U. El Bosque
• Idioma: eng
• OAI Identifier: oai:repositorio.unbosque.edu.co:20.500.12495/11084
• Acceso en línea: https://hdl.handle.net/20.500.12495/11084; https://doi.org/10.1016/j.fas.2023.05.006
• Palabra clave: Reamputación; Úlcera de pie diabético; Pie diabético; Amputación de extremidad inferior; Infección; Análisis de supervivencia; Reamputation; Diabetic foot ulcer; Diabetic foot; Lower extremity amputation; Infection; Survival analysis
• License: Attribution-NonCommercial-NoDerivatives 4.0 Internacional