Analysis of Predictor Factors and Comorbidities About Lower-Extremity Repetitive Amputation in Diabetic Foot Ulcer and Infection: A Retrospective Study

Category: Diabetes Introduction/Purpose: About 12-25% of diabetic patients had foot ulcers during their lifetime, which has been reported in several studies that not only reduce the quality of life but also increase the risk of amputation due to infection and increase mortality. However, there are insufficient studies on risk factors and comorbidities on re-amputation due to uncontrolled infection and necrosis after amputation. Therefore, the purpose of this study is to investigate the predictors of lower-extremity amputation or re-amputation in diabetic foot ulcer patients and the effects of comorbidities. Methods: Among the patients who underwent amputation or re-amputation for diabetic foot ulcer at a single institution from April 2019 to March 2021, 60 cases, who were followed up for at least 1 year, were investigated. The group that underwent amputation and the group that had more than one amputation were divided into two groups, and the clinical characteristics and comorbidities of each group were comparatively evaluated. Clinical factors were Wagner stage, the anatomical level of the amputation, the presence or absence of osteomyelitis in radiology, glycated hemoglobin, the difference in results according to the bacterial culture test, and the presence or absence of peripheral blood vessel occlusion, and the reperfusion procedure. Results: The average follow-up period was 12.7 (6-24 months), and the higher the Wagner stage, the higher the rate of re-amputation was statistically significant (OR 1.8, 95%CI 1.4 to 2.4; p=.001). The rate of re-amputation was significantly higher in the group that failed to re-perfuse peripheral blood vessels preoperatively than in the group that succeeded (OR 7.4, 95% CI 2.0 to 27.5; p=.003). Uncontrolled diabetes was confirmed by glycated albumin was predicted the need for repetitive amputation (OR 1.08, 95% CI 0.8 to 2.7; p=.001). In addition, there was a high rate of re-amputation in diabetic foot ulcers and infections identified by polymicrosomal infection. (OR 8.4, 95% CI 1.0 to 69.5; p=.026) Conclusion: In patients with diabetic foot ulcers and severe infections, who have a peripheral vascular obstruction, which failed vascular intervention, and who had high glycated albumin was performed from the initial amputation below the major joint in the proximal lower extremity, resulting in reduced patient mortality and morbidity. In addition, the results of the treatment varied depending on the infected bacteria. Re-amputation free survival of diabetic foot ulcer Kaplan-Meier curves for reamputation-free survival of diabetes patients with diabetic foot ulcers over 3 year, depending on enterococal infection (log-rank test p= 0.03).