Abstract
This study aimed to determine the association of risk factors with a major re-amputation in Malaysian diabetes patients. This is a retrospective review and analysis of a patient cohort obtained from National Orthopedic Registry Malaysia (NORM) between June 2008 and December 2009. Re-amputation is defined as the removal of bones to advance to a higher level of amputation. An amputation can be regarded as a re-amputation if it is performed on the same limb within the same admission period and is also considered to be the final level of amputation. The plausible risk factors that are reported as importantly associated with the risk of re-amputation include patients’ baseline socio-demographic factors, clinical characteristics, and treatment outcomes, and these are analyzed both separately and together. A total of 137 patients were eligible for inclusion into the study. Only 23.4% of the total 137 patients were actually re-amputated. Baseline clinical characteristics such as the presence of neuropathy (p = 0.004), nephropathy (p = 0.005), and the topical application of emollient (p = 0.003) are found to be associated with requirement for a major re-amputation. Almost a quarter of patients who had an initial amputation will require a re-amputation. The patients who were at a particularly high risk of the need for re-amputation were those experiencing complications of diabetes such as nephropathy. Topical application of emollient is necessary to delay the need for re-amputation and if possible, avoid it altogether.
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References
Santos ICRV, Sobreira CMM, Chagas MSC, Xavier Filho JC. Diabetic foot amputation according to amputations situation. J Nurs UFPE. 2011;5(6):1390–6. doi:10.5205/01012007.
Izumi Y, Satterfield K, Lee S, Harkless LB. Risk of reamputation in diabetic patients stratified by limb and level of amputation: a 10-year observation. Diabetes Care. 2006;29:566–70. doi:10.2337/diacare.29.03.06.dc05-1992.
Reiber GE, Boyko EJ, Smith DG. Lower extremity foot ulcers and amputations in diabetes. In: National Institutes of Health, second ed, Diabetes in America. Washington: NIH Publication; 1995. p. 349–85.
Reiber GE. The epidemiology of foot ulcers and amputations in the diabetic foot. In: Bowker JH, Pfeifer MA, editors. The diabetic foot. St. Louis: Mosby; 2001. p. 13–32.
International Diabetes Federation. IDF Diabetes Atlas, fifth ed. 2011. www.idf.org/diabetesatlas. Accessed 14 November 2015.
Adler AI, Boyko EJ, Ahroni AJ, Stensel V, Forsberg RC, Smith DG. Risk factors for diabetic peripheral sensory neuropathy: results of the Seattle prospective diabetic foot study. Diabetes Care. 1997;20:1162–7. doi:10.2337/diacare.20.7.1162.
Tseng WP. Blackfoot disease in Taiwan: a 30-year follow-up study. Angiology. 1989;40:547–58.
Dormandy J, Heeck L, Vig S. Major mputations: clinical patterns and predictors. Semin Vasc Surg. 1999;12:154–61.
Ebskov B, Josephsen P. Incidence of reamputation and death after gangrene of the lower extremity. Prosthet Orthotics Int. 1980;4(2):77–80. doi:10.3109/03093648009164567.
Bild DE, Selby JV, Sinnock P, Browner WS, Braveman P, Showstack JA. Lower-extremity amputation in people with diabetes: epidemiology and prevention. Diabetes Care. 1989;12:24–31. doi:10.2337/diacare.12.1.24.
Kono Y, Muder RR. Identifying the incidence of and risk factors for reamputation among patients who underwent foot amputation. Ann Vasc Surg. 2012;26:1120–6. doi:10.1016/j.avsg.2012.02.011.
Choi SJ, Lee CB, Kim MS, Ha JH, Park HT. Incidence and risk factors of ipsilateral foot and lower limb reamputation in diabetic foot patients. J Korean Foot Ankle Soc. 2011;15(1):7–12.
Chew H, Ghazali SS, Ismail M, Haniff J, Bujang MA. Age ≥ 60 years was an independent risk factor for diabetes-related complications despite good control of cardiovascular risk factors in patients with type 2 diabetes mellitus. Exp Gerontol. 2013;48(5):485–91. doi:10.1016/j.exger.2013.02.017.
Abdelhafiz AH, Nahas ME, Oliveira JMF. Management of diabetic nephropathy in older patients: a need for flexible guidelines. Postgrad Med. 2014;126(4):171–7. doi:10.3810/pgm.2014.07.2794.
Adler AI, Ahroni JH, Boyko EJ, Smith DG. Lower-extremity amputation in diabetes: the independent effects of peripheral vascular disease, sensory neuropathy, and foot ulcers. Diabetes Care. 1999;22(7):1029–35. doi:10.2337/diacare.22.7.1029.
Sun JH, Tsai JS, Huang CH, Lin CH, Yang HM, Chan YS, et al. Risk factors for lower extremity amputation in diabetic foot disease categorized by Wagner classification. Diabetes Res Clin Pract. 2012;95(3):358–63. doi:10.1016/j.diabres.2011.10.034.
Nerone VS, Springer KD, Woodruff DM, Atway SA. Reamputation after minor foot amputation in diabetic patients: risk factors leading to limb loss. J Foot Ankle Surg. 2013;52(2):184–7. doi:10.1053/j.jfas.2012.11.015.
Goodfield MJD, Millard LG. The skin in diabetes mellitus. Diabetologia. 1988;31:567–75.
Acknowledgements
We would like to extend the appreciation to Director General of Ministry of Health for his support to publish the work. We thank also to the National Orthopedic Registry Malaysia for providing the data and also to Mr. John Hon Yoon Khee for his effort in proofreading this manuscript.
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This study involved human participants and performed in accordance with the ethical standards of Medical Research and Ethics Committee with registration number NMRR-08-1349-2597 and in accordance with the 1964 Declaration of Helsinki.
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Informed consent was not obtained from individual participants because this study used a patient registry database.
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Abdullah, A.A.S., Ismail, I. & Bujang, M.A. Association of risk factors with a major re-amputation in Malaysian diabetic patients: a retrospective cohort analysis of patient registry. Int J Diabetes Dev Ctries 38, 95–99 (2018). https://doi.org/10.1007/s13410-017-0551-8
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DOI: https://doi.org/10.1007/s13410-017-0551-8