Abstract
Background
Lower extremity amputations (LEA) are serious complications of the infected diabetic foot. Subsequent amputations are underreported and the occurrence of an ipsilateral second re-amputation (third amputation) is unknown.
Methods
This is a retrospective study of a continuous series of patients admitted for LEA due to diabetic foot complications, with a minimum of 2 years of follow-up after the first re-amputation. A total of 111 patients comprising 149 index amputation; 97 and 52 cases in the minor and major type groups, respectively. The primary outcomes were the observed frequencies of first and second re-amputations with comparative analysis based on amputation type. Logistic regression analysis was used to look for independent risk factors.
Results
Out of 149 index LEA cases, 111 cases (74.5%) had no re-amputation. First re-amputation frequencies were 25.5%, 35%, and 7.7% for the whole sample, minor, and major groups, respectively. Second re-amputation frequencies were 34.2%, 31.6%, and 2.6% for the whole sample, minor, and major groups, respectively. Infection re-occurrence was the cause in 89.5% and 100% of cases for first and second re-amputation. Out of the 13 second re-amputation cases in the minor group, 30.7% were minor and 69.3% were major amputations. The mean time for the first re-amputation was 5.4 ± 9.4 months and that for the second re-amputation was 9.5 ± 7.1 months (p = .04). For the first re-amputation, independent risk factors were smoking (p = .04) and creatinine level (p = .02) outcome. For the second re-amputation outcome, male sex was the only independent variable (p = .03).
Conclusion
This study demonstrated that a second re-amputation, mostly major, was needed in more than one-third among first re-amputation cases. Second re-amputation could be a relevant major endpoint outcome in this frail population.
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