Amputation rate in 147 Turkish patients with diabetic foot (original) (raw)

Exp Clin Endocrinol Diabetes 1998; 106(5): 404-409
DOI: 10.1055/s-0029-1212006

Original

The Hacettepe University Hospital Experience

Hacettepe University School of Medicine, Department of Internal Medicine, Division of Endocrinology, Ankara, Turkey

Further Information

Publication History

Publication Date:
14 July 2009 (online)

Summary

To determine the lower extremity amputation rate and the risk factors for amputation, we analysed the medical records of 147 Turkish diabetic patients who have been referred to the clinic with diabetic foot. Eleven patients (7.5%) had type 1, and 136 patients (92.5%) had type 2 diabetes mellitus. Fifty-four patients (36.7%) have undergone amputation due to diabetic foot. Femoro-popliteal by-pass has been performed in 4 patients in the non-amputees group who did not have gangrene. None of the patients in the amputees group has undergone a revascularisation procedure. Considering all lower-extremity amputations in the group studied, 25.9% were transphalangial amputations, 3.7% were transmetatar-sal amputations, 7.4% were Syme type amputations, 51.9% were below-knee amputations, and 11.1% were above-knee amputations.

In a logistic regression model, age, gender, duration of diabetes, smoking history, hypertension, retinopathy, nephropathy, and peri-pheral neuropathy were insignificant factors in determining the risk of amputation. In contrast, presence of peripheral vascular disease (odds ratio 4.0, 95% CI 1.17−13.4; p = 0.03), osteomyelitis (odds ratio 3.73, 95% CI 1.08−12.6; p = 0.04) and gangrene (odds ratio 30.8, 95% CI 7.39−121.5; p < 0.0001) were found to be the signifi-cant predictors of amputation. The mortality rate due to ampu-tation during hospital stay was 13.2%. These data suggest that lower extremity amputation is a frequently encountered outcome of the hospitalized patients in Turkish diabetic population with dia-betic foot which mainly occur due to peripheral vascular disease, osteomyelitis and gangrene. Lack of adequate vascularisation pro-cedures might have contributed to a high percentage of major am-putations in the group studied. Population-based studies should be undertaken in order to determine the status of lower extremity amputation as a whole in Turkish diabetic population.

Key words

Diabetes mellitus - amputation - diabetic foot - Turkish population