D9. Gait Impairments Seen in Diabetic Neuropathy Patients after Surgical Intervention for Open Wounds

Shan, Holly; Haffner, Zoë K.; DiBello, John R.; Begley, Colin P.; Huffman, Samuel S.; Pogany, Charli A.; Garada, Firras; Kavanaugh, Mariam R.; Evans, Karen K.; Steinberg, John S.; Atves, Jayson N.

doi:10.1097/01.gox.0000934648.72452.a5

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“…9 A recent study found that neuropathic patients with chronic wounds requiring surgical intervention demonstrated poorer gait function in all parameters compared with nondiabetic controls, concluding that patients at risk of severe diabetic neuropathy should be further counseled to avoid greater ambulatory impairment. 23 Despite the well-recognized importance of regular mobility assessments in diabetic patients, ours is the first study to examine the utility of assessing ambulatory status before DFU diagnosis as an independent predictor of amputation and outcomes. Within 30-days after DFU diagnosis, NA and AWAD status were associated with a 319% and 209% increase in the odds of ED visits, and AWAD status was associated with a 189% increase in the odds of hospital readmission.…”

Section: Discussionmentioning

confidence: 96%

Ambulatory Status before Diabetic Foot Ulcer Development as a Predictor of Amputation and 1-Year Outcomes: A Retrospective Analysis

Clegg,

Tasman,

Whiteaker

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Up to 25% of people with diabetes develop a diabetic foot ulcer (DFU) during their lifetime, which precedes approximately 85% of nontraumatic lower limb amputations. Diabetic limb salvage has been at the forefront of recent research, as major amputation is associated with 5-year mortality rates of 52%–80%. We sought to determine if ambulatory status before DFU diagnosis is predictive of amputations and outcomes within 1 year, as no studies have directly examined this relationship. Methods: A retrospective review of patients diagnosed with DFUs from January 2011 to December 2021 was performed. Patients aged 18 years or more with type II diabetes were included. Ambulatory status was defined as the primary form of mobility reported by the patient before development of DFU, and was categorized as independent ambulation, ambulatory with assisting device (AWAD), or nonambulatory (NA). Statistical analyses included χ2, multinomial, and multivariable logistic regressions. Results: After review, 506 patients were included. NA (OR = 5.10; P = 0.002) and AWAD status (OR = 2.77; P = 0.01) before DFU development were predictive of major (below or above-knee) amputation during hospitalization, emergency department visits within 30-days (NA: OR = 4.19; P = 0.01, AWAD: OR = 3.09; P = 0.02), and mortality within one-year (NA: OR = 4.19; P = 0.01, AWAD: OR = 3.09; P = 0.02). AWAD status was also associated with increased risk of hospital readmission (OR = 2.89; P < 0.001) within 30-days and any amputation (OR = 1.73; P = 0.01) within 1 year. Conclusions: In patients with DFUs, NA and AWAD status were predictive of major amputation during hospitalization and are associated with poorer 1-year outcomes, including mortality. Ambulatory status assessment may be used to inform DFU treatment approaches.

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Section: Discussionmentioning

confidence: 96%