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

• 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
• ISSN: 1056-8727; 1873-460X
• DOI: 10.1016/S1056-8727(97)98004-1

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.