Risk factors for major lower limb amputations in diabetic patients hospitalized for diabetic foot ulcer

Abstract

Background: Amputations in diabetes patient lead to high postoperative morbidity and mortality Aim: to indentify the risk factors for major lower limb amputations in diabetic patients hospitalized in endocrinology department. Methods: It was a descriptive retrospective study including diabetic patients hospitalized in the endocrinology department of the Rabta Hospital for management of an infected foot lesion. We distributed the patients into 2 groups: group 1: patients with major amputation of the lower limb and group 2: patients who have had an amputation below the ankle or who had a conservative treatment. Results: One hundred and twenty patients were included. The mean age was 59 ±11.9 years [28-97]. Twenty one (17.5%) patients had a major amputation (group 1). The frequency of obliterating arterial disease and gangrenes of the lower limbs were significantly higher in group 1. The extent of lesions> 2cm and the frequency of osteitis were comparable between the two groups. The frequency of hyperleukocytosis and mean C reactive protein were significantly higher in group 1. Antibiotic therapy prescribed during hospitalization was targeted in 30% of cases in group 1 versus 12.9% in group 2 (p = 0.05). Obliterating arterial disease, gangrenes and long duration of diabetes were independant risk factors significant on binary regression analysis. Conclusion: Some risk factors associated with major amputations are modifiable, such as arteriopathy obliterating of the lower limbs. A larger and prospective study would allow a better analysis of the predictive factors of major amputations.