Risk Factors for Early Major Amputation in the First Diabetic Forefoot Amputation

Category: Diabetes; Other Introduction/Purpose: Subsequent major amputations within 1 year after initial forefoot amputations are sometimes necessary when other options for saving the foot are unavailable. Risk factors for early major amputation should be analyzed for a successful limb salvage strategy. This study aimed to analyze the risk factors for early major amputation after initial diabetic forefoot amputation. Methods: In this retrospective cohort study, clinically important variables of 808 first diabetic forefoot amputations were analyzed. Major amputations were performed in 104 patients (12.9%) throughout follow-up, and 77 (74%) of 104 patients had their major amputation within l year. Cox proportional hazards were examined to assess the risk factors for major amputation performed within 1 year. Results: In univariate analysis, 19 possible risk factors significantly differed between patients with and without early major amputation. In stepwise multivariable analysis, age, body weight, chronic renal failure (CRF), intermediate column amputation level, and C-reactive protein (CRP; mg/dl) level significantly differed. CRF showed the largest hazard ratio (HR) for early major amputation: 4.538 (95% confidence interval: 2.667-7.723, p-value < 0.0001). Age, weight, intermediate column amputation level, and CRP level had relatively low HRs: 1.032, 0.968, 1.367, and 1.078, respectively. Conclusion: CRF was a strong independent risk factor for early major amputation in the first diabetic forefoot amputation. Furthermore, patients with CRF underwent earlier and more major amputations throughout their follow-up. Before the surgical treatment, patients with CRF should be educated in terms of the high probability (>20%) of early major amputation.