Assessing the Long-Term Outcomes of Minor Lower Limb Amputations: A 5-Year Study

Swerdlow

Journal of Foot and Ankle Research

et al. 2020

531

350

Background: In 2007, we reported a summary of data comparing diabetic foot complications to cancer. The purpose of this brief report was to refresh this with the best available data as they currently exist. Since that time, more reports have emerged both on cancer mortality and mortality associated with diabetic foot ulcer (DFU), Charcot arthropathy, and diabetes-associated lower extremity amputation. Methods: We collected data reporting 5-year mortality from studies published following 2007 and calculated a pooled mean. We evaluated data from DFU, Charcot arthropathy and lower extremity amputation. We dichotomized high and low amputation as proximal and distal to the ankle, respectively. This was compared with cancer mortality as reported by the American Cancer Society and the National Cancer Institute. Results: Five year mortality for Charcot, DFU, minor and major amputations were 29.0, 30.5, 46.2 and 56.6%, respectively. This is compared to 9.0% for breast cancer and 80.0% for lung cancer. 5 year pooled mortality for all reported cancer was 31.0%. Direct costs of care for diabetes in general was $237 billion in 2017. This is compared to $80 billion for cancer in 2015. As up to one-third of the direct costs of care for diabetes may be attributed to the lower extremity, these are also readily comparable. Conclusion: Diabetic lower extremity complications remain enormously burdensome. Most notably, DFU and LEA appear to be more than just a marker of poor health. They are independent risk factors associated with premature death. While advances continue to improve outcomes of care for people with DFU and amputation, efforts should be directed at primary prevention as well as those for patients in diabetic foot ulcer remission to maximize ulcer-free, hospital-free and activity-rich days.Up to one-third of the half billion people with diabetes worldwide will develop a diabetic foot ulcer (DFU) over the course of their lifetime. Over half of DFUs will develop an infection. Of these, 17% will require an amputation [1][2][3][4]. Remarkably, people with diabetes fear amputation worse than death [5]. For patients who do not receive amputation and are able to heal their ulcer, 40% will develop a recurrence within 1 year, 65% within 5 years, and greater than 90% within 10 years [1,6]. The greatest risk factor for a DFU is a previously healed DFU. These silent, sinister complications are now a leading cause of disability worldwide [7,8]. Despite this high prevalence and morbidity, federal funding for studies related to DFUs remains at a 600-plus-fold disadvantage compared to other diabetes research in terms of public

mentioning

confidence: 99%

Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer

Swerdlow

Journal of Foot and Ankle Research

et al. 2020

531

350

“…Trends in amputation type discussed in our study played a significant role because minor amputations showed a lower rate of postoperative mortality compared to major amputations. Compared to an overall 5-year mortality rate of 30% to 40% following major amputation, a 27% overall 5-year mortality rate was reported in patients undergoing minor amputation 17. As the majority of patients scheduled for amputation exhibit comorbid conditions such as ischemic heart disease, stroke, and renal impairment, they are vulnerable to operations.…”

Section: Discussionmentioning

confidence: 98%

Trends in Lower Limb Amputation in Patients with Diabetic Foot Based on Vascular Intervention of Peripheral Arterial Disease in Korea: a Population-based Nationwide Study

et al. 2019

Background Peripheral arterial disease (PAD) is known as the greatest risk factor affecting the amputation of diabetic foot. Thus, it is crucial to understand the epidemiology of PAD associated with diabetic foot and the relationship between PTA and amputation in predicting prognosis. However, no such multi-year data are available in Korea. Thus, the purpose of this study was to investigate trends of amputation involving diabetic foot based on vascular interventions for PAD in Korea. Methods This study was conducted using six-year data obtained from Health Insurance Review and Assessment Service from January 1, 2011 to December 31, 2016. Our study included data pertaining to diabetic foot, PAD, and vascular intervention codes (percutaneous transluminal angioplasty [PTA, M6597], percutaneous intravascular installation of stent-graft [PIISG, M6605], and percutaneous intravascular atherectomy [PIA, M6620]). We analyzed the number of vascular interventions and minor and major amputations each year. The relationship between annual amputation and vascular intervention was analyzed using χ 2 test. Results The overall number of vascular interventions increased from 253 (PTA, 111; PIISG, 140; and PIA, 2) in 2011 to 1,230 (PTA, 745; PIISG, 470; and PIA, 15) in 2016. During the same period, the number of minor amputations increased from 2,534 to 3,319 while major amputations decreased from 980 to 956. The proportion of minor amputations among patients who underwent vascular intervention was significantly increased from 19.34% in 2011 to 21.45% in 2016 while the proportion of major amputations among these patients was significantly reduced from 9.88% to 4.27%. In addition, the association between vascular intervention and amputation increased from 0.56 (spearman correlation coefficient) in 2011 to 0.62 in 2016. Conclusion In diabetic foot patients, increase in vascular intervention resulted in a change in amputation pattern, showing statistically significant correlation.

“…A diabetic foot ulceration (DFU) multidisciplinary team approach is highly recommended and has been shown to be the most effective strategy for reducing the rates of amputation and mortality in diabetic foot disorders ( 6 , 7 ). Ideally, this team should include a diabetologist, podiatrist, infectious disease specialist, orthopedic surgeon, vascular surgeon, physiotherapist orthotist, diabetes nurse, and an interventional radiologist ( 8 , 9 ).…”

Section: Introductionmentioning

confidence: 99%

Current knowledge of morbidities and direct costs related to diabetic foot disorders: a literature review

Waibel,

Uçkay,

Soldevila-Boixader

et al. 2024

Front. Endocrinol.

Diabetes is a chronic disease associated with numerous complications including diabetic foot disorders, which are associated with significant morbidity and mortality as well as high costs. The costs associated with diabetic foot disorders comprise those linked to care (direct) and loss of productivity and poor quality of life (indirect). Due to the constant increase in diabetes prevalence, it is expected that diabetic foot disorder will require more resources, both in terms of caregivers and economically. We reviewed findings on management, morbidity, mortality, and costs related to diabetic foot disorder.