A retrospective analysis of amputation rates in diabetic patients: can lower extremity amputations be further prevented?

Cardiovascular Diabetology

Original Investigation

Buster Sandgren¹  Carl Wendel²  Michael Alvarsson³  Kerstin Brismar³  Alexandra Alvarsson⁴ 

[1] Department of Orthopedics, Karolinska University Hospital, Stockholm, Sweden;Department of Trauma & Orthopedics, Danderyd University Hospital, Stockholm, Sweden;Rolf Luft Centre for Diabetes Research, Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden;Rolf Luft Centre for Diabetes Research, Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden;Center for Molecular Medicine, L8:01, Karolinska University Hospital, 171 76, SE, Stockholm, Sweden;

关键词: Lower extremity amputations;    Diabetic foot;    Foot ulcer;    Diabetic complications;   

DOI  :  10.1186/1475-2840-11-18

 received in 2011-11-02, accepted in 2012-03-02,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundLower extremity amputations are costly and debilitating complications in patients with diabetes mellitus (DM). Our aim was to investigate changes in the amputation rate in patients with DM at the Karolinska University Hospital in Solna (KS) following the introduction of consensus guidelines for treatment and prevention of diabetic foot complications, and to identify risk groups of lower extremity amputations that should be targeted for preventive treatment.Methods150 diabetic and 191 nondiabetic patients were amputated at KS between 2000 and 2006; of these 102 diabetic and 99 nondiabetic patients belonged to the catchment area of KS. 21 diabetic patients who belonged to KS catchment area were amputated at Danderyd University Hospital. All patients' case reports were searched for diagnoses of diabetes, vascular disorders, kidney disorders, and ulcer infections of the foot.ResultsThere was a 60% reduction in the rate of amputations performed above the ankle in patients with DM during the study period. Patients with DM who underwent amputations were more commonly affected by foot infections and kidney disorders compared to the nondiabetic control group. Women with DM were 10 years older than the men when amputated, whereas men with DM underwent more multiple amputations and had more foot infections compared to the women. 88% of all diabetes-related amputations were preceded by foot ulcers. Only 30% of the patients had been referred to the multidisciplinary foot team prior to the decision of amputation.ConclusionsThese findings indicate a reduced rate of major amputations in diabetic patients, which suggests an implementation of the consensus guidelines of foot care. We also propose further reduced amputation rates if patients with an increased risk of future amputation (i.e. male sex, kidney disease) are identified and offered preventive treatment early.

【 授权许可】

CC BY   
© Alvarsson et al; licensee BioMed Central Ltd. 2012