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Does the Proximity of an Amputation, Length of Time Between Foot Ulcer Development and Amputation, or Glycemic Control at the Time of Amputation Affect the Mortality Rate of People with Diabetes who Undergo an Amputation?

Jones, Richard N., MS, PA-C; Marshall, William P., MD

Advances in Skin & Wound Care: March 2008 - Volume 21 - Issue 3 - p 118-123
doi: 10.1097/01.ASW.0000305419.73597.5f
FEATURES: ORIGINAL INVESTIGATION
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OBJECTIVES: The main purpose of the authors' research was to compare the 3- and 5-year mortality rates of diabetic patients who have undergone a lower-extremity amputation, evaluating the proximity of the amputation in 3 groups (toe and foot amputation, BKA, and AKA), the timing of the amputation (within or after 2 years of the onset of the foot ulcer), and the effect of glycemic control at the time of amputation, regardless of the level of amputation.

METHODS AND DESIGN: The subjects were 80 male inpatients at Illiana Veterans Health Care System who had diabetes, diabetic neuropathy, peripheral vascular disease, and a diabetic foot ulcer that resulted in an amputation. Of the 80 patients, 29 had a toe amputation, 30 had a BKA, and 21 had an AKA. The mean age in all 3 groups was 68.5 years ± 7.2 years. The authors used the hemoglobin A1C (Hgb A1C) level to assess glycemic control.

MAIN OUTCOME MEASURES: Several χ2 tests were used to compare the 3- and 5-year mortality rates among the amputation groups. An Hgb A1C level of 8% or less defined good glycemic control; an Hgb A1C level of more than 8% defined poor glycemic control. A χ2 test was used to compare glycemic control, the level of amputation, and the mortality rate. A χ2 test was also used to evaluate the length of time between ulcer formation and amputation, the level of amputation, and the mortality. All statistics were done using SPSS 10.0 student version.

CONCLUSIONS: The research revealed a statistically significant difference in mortality among the 3 groups at 3 and 5 years. No statistically significant difference in mortality in patients with good glycemic control and patients with bad glycemic control was found. At 3 years, a statistically significant difference in mortality existed between patients who had an amputation within 2 years of ulcer formation and those who had an amputation after 2 years. At 5 years, no statistically significant difference existed between these 2 groups.

Results of this 80-patient investigation revealed a statistically significant difference in mortality among the 3 study groups at 3 and 5 years. No statistically significant difference in mortality in patients with good glycemic control and patients with bad glycemic control was found.

Richard N. Jones, MS, PA-C, is a Physician Assistant in Endocrinology, and William P. Marshall, MD, is Deputy Chief of Staff at Illiana Veterans Health Care System, Danville, IL.

Submitted January 23, 2006; accepted in revised form March 21, 2007.

© 2008 Lippincott Williams & Wilkins, Inc.