Change in Major Amputation Rate in a Center Dedicated to Diabetic Foot Care During the 1980s: Prognostic Determinants for Major Amputation

From 1990 to 1993, 115 diabetic patients were consecutively hospitalized in our diabetologic unit for foot ulcer and 27 (23.5%) major amputations were carried out. The major amputation rate of this series of cases was compared with that occurring in diabetic subjects taken into our hospital for foot...

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Bibliographic Details
Published in:	Journal of diabetes and its complications Vol. 12; no. 2; pp. 96 - 102
Main Authors:	Faglia, Ezio, Favales, Fabrizio, Aldeghi, Antonio, Calia, Patrizia, Quarantiello, Antonella, Barbano, Pierremigio, Puttini, Maurizio, Palmieri, Bruno, Brambilla, Giorgio, Rampoldi, Antonio, Mazzola, Ester, Valenti, Luigi, Fattori, Gianfranco, Rega, Vincenzo, Cristalli, Aldo, Oriani, Giorgio, Michael, Michael, Morabito, Alberto
Format:	Journal Article
Language:	English
Published:	New York, NY Elsevier Inc 01-03-1998 Elsevier Science
Subjects:	Amputation - statistics & numerical data Analysis of Variance Associated diseases and complications Biological and medical sciences Blood Pressure Confidence Intervals Diabetes. Impaired glucose tolerance Diabetic Foot - physiopathology Diabetic Foot - surgery Diabetic Foot - therapy Endocrine pancreas. Apud cells (diseases) Endocrinopathies Female Foot Ulcer - surgery Foot Ulcer - therapy Humans Hyperbaric Oxygenation Male Medical sciences Middle Aged Multivariate Analysis Odds Ratio Prognosis Retrospective Studies Italy Europe Endocrinopathy Human Diabetes mellitus Time variation Treatment Surgical amputation Surgery Disease of the foot Adult Complication Decision criterion Therapeutic protocol Elderly
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Summary:	From 1990 to 1993, 115 diabetic patients were consecutively hospitalized in our diabetologic unit for foot ulcer and 27 (23.5%) major amputations were carried out. The major amputation rate of this series of cases was compared with that occurring in diabetic subjects taken into our hospital for foot ulcer in two previous periods: 1979–1981 (17 major amputations in 42 inpatients or 40.5%) and 1986–1989 (26 major amputations in 78 inpatients or 33.3%). The comparison shows a progressive reduction in major amputation rate [Odds ratio 0.66, 95% confidence interval (CI) 0.46–0.96]. Univariate and multivariate analysis, carried out in the population of the 1990–1993 period, in order to detect the independent factors associated with major amputation show the following prognostic determinants of major amputation: Wagner grade (odds ratio 7.69, CI 1.58–37.53), prior stroke (odds ratio 35.05, CI 3.14– 390.53), prior major amputation (odds ratio 3.49, CI 1.26–9.38), transcutaneous oxygen level (odds ratio 1.06, CI 1.01–1.12), and ankle-brachial blood pressure index (odds ratio 4.35, CI 1.58–12.05), while an independent protective role was attributed to hyperbaric oxygen treatment (odds ratio 0.15, CI 0.03–0.64). In accordance with other studies, we, therefore, conclude that a comprehensive protocol as well as a multidisciplinary approach in a dedicated center can assure a decrease in major amputation rate. The parameters of limb perfusion were the modifiable prognostic determinants most strongly predictive for amputation.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1056-8727 1873-460X
DOI:	10.1016/S1056-8727(97)98004-1