Risk factors for primary major amputation in diabetic patients
Keywords:
Diabetes mellitus, Diabetic foot, Amputation, Lymphangitis, Bacterial infectionsAbstract
CONTEXT AND OBJECTIVE: Diabetic patients present high risk of having to undergo minor or major amputation during their lifetimes, be- cause of ischemia or infection. The aim of this study was to identify and quantify risk factors for major amputation in diabetic patients with foot infections. DESIGN AND SETTING: Retrospective clinical- surgical trial at the Vascular Surgery Service of Santa Casa de São Paulo. METHODS: Ninety-nine patients with diabetic foot infections who underwent 129 hospitalizations in the Vascular Surgery Unit were analyzed in accordance with a pre-established protocol to compare two groups of diabetic patients: one that underwent major amputations and the other that underwent minor amputations or debridements. The patients were predominantly male, in their sixth decade of life, and had type 2 diabetes mellitus. Chronic arterial insufficiency, age, diabetes mellitus duration, ascending lymphan- gitis, calcaneal lesions, Wagner’s classification, laboratory tests and different microorganisms in deep tissue cultures were the risk factors evalu- ated in all patients. RESULTS: The statistically significant risk factors for major amputation included age, ascending lymphangitis (odds ratio, OR: 2.5), calcaneal lesions (OR: 10.5), Wagner grade 5 lesions (OR: 3.4), chronic arterial insufficiency without possibility of revascularization (OR: 5.4) and diabetes duration. Presence of Gram-positive microorganisms was associated with the need of major amputation. The serum urea, creatinine, glucose and white blood cell levels were not significant risk factors for major amputation. CONCLUSIONS: The risk factors for major am- putation were: age, ascending lymphangitis, calcaneal lesions, Wagner grade 5 lesions, arterial insufficiency, diabetes duration and Gram-positive microorganisms in cultures.
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