Clinical ResearchIdentifying the Incidence of and Risk Factors for Reamputation Among Patients Who Underwent Foot Amputation
Introduction
In 2006, 66,000 patients were admitted for nontraumatic lower-extremity amputation with diabetes in the United States.1 Unlike patients who undergo trauma- or cancer-related amputations, in patients with peripheral vascular disease or diabetes, progress of their underlying disease can lead to ipsilateral reamputation.2, 3, 4 Izumi et al.3 reported that reamputation rate was 60% at 5 years. The mortality rate was also high. Long-term survival among patients who had above-the-knee or below-the-knee amputation was 62% at 1 year and 29% at 5 years.5
Regarding the risk factors for reamputation, Skoutas et al.6 reported age and heel lesions were associated with reamputation. Stone et al.7 noted that end-stage renal disease and severe ischemia were the risk factors for a nonhealing wound.
Few studies identified similar factors as being associated with an increased risk of reamputation. Whether postoperative infection increases the risk of amputation has never been studied, nor has the effect of the duration of postoperative antimicrobial therapy.
In this observational cohort study, we aimed to 1) identify the incidence of and risk factors for ipsilateral reamputation after forefoot amputation; 2) evaluate whether postoperative infection increases the risk of reamputation; 3) evaluate whether the risk of reamputation was reduced by the duration of antimicrobial therapy after amputation.
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Subjects
With approval from the Veterans Affairs Pittsburgh Healthcare System Institutional Review Board, the medical records and imaging data of the patients who had foot amputation for nontraumatic reason from January 2002 to December 2004 at the Veterans Affairs Pittsburgh Healthcare System (146 beds) were reviewed retrospectively. Patients who died within 1 month after amputation or were lost to follow-up within 6 months were excluded. If patients had multiple amputations in 3 years, only the
Patient Population
Among 123 patients who had foot amputations from January 2002 to December 2004, 116 were identified following the inclusion criteria (Table I). One patient died, and six patients were lost to follow-up. One hundred fifteen patients (99.1%) were male, and the average age (± standard deviation) of all patients was 66.8 ± 11.0 years. Ninety-three patients (80.2%) had diabetes.
Fifty-seven patients (49.1%) had ipsilateral reamputation within 3 years after their first surgeries. Fifty-three patients
Discussion
This study demonstrated the incidence of and risk factors for ipsilateral reamputation after forefoot amputation. Fifty-seven patients (49.1%) had ipsilateral reamputation within 3 years after their first surgeries. The previous studies reported a 21.5% incidence of reamputation in 18 months6 and 60% in 10 years.2 In all, 78.9% patients received reamputation within 6 months after their first amputation, which is consistent with the study by Skoutas et al.,6 and 59.6% of patients with
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2022, Journal of Orthopaedic TranslationCitation Excerpt :Furthermore, postoperative health-related quality of life was better than preoperatively (see videos), supporting the favorable outcome documented in a previous report using TTT [19]. On the other hand, patients with DFUs usually are older and with multiple comorbidities, and thus the rates of re-amputation, contralateral amputation, and premature mortality are relatively high after major amputation [51,57,59]. Thus, limb salvage using TTT may be more suitable than major amputation for patients with recalcitrant DFUs.
Analysis of repeated lesions after diabetic forefoot amputation
2022, Diabetes Research and Clinical PracticeCitation Excerpt :With challenges in adjusting for variables, previous clinical studies on diabetic foot evaluated the risk factors for recurrence and reamputation [6–8]. Despite controversies, the well-known risk factors for diabetic foot recurrence and reamputation are type 1 diabetes, diabetic polyneuropathy, infection, gangrene, smoking, peripheral arterial disease, chronic renal failure, and dialysis [9–15]. Patients that underwent a previous amputation have a higher risk of recurrence of diabetic foot diseases, such as ulcer, gangrene, and infection.
Analysis of Early Lower Extremity Re-amputation
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