Differing Toe Pressure Thresholds to Predict Healing of Forefoot Amputations in Diabetic and Non-Diabetic Patients

Abstract

primary outcome and was assessed using a five-item ordinal scale (1, strongly regret; 5, absolutely no regret) survey item administered by telephone or mail 30 to 90 days after surgery. Regret was categorized as any regret (score, 1-4) vs no regret (score, 5). Logistic regression models were used to examine the associations between decisional regret, procedure type, and 30-day postoperative complications.Results: A total of 572 patients were included in the analysis (mean age, 68.5 6 11.0 years; 190 women [33%]; 433 [76%] non-Hispanic white). The procedures included 110 LE amputations (19.2%), 172 LE revascularizations (30.1%), 77 AAA repairs (13.5%), and 213 CEAs (37.3%). The overall prevalence of regret was 14.2%. Patients undergoing LE amputation or revascularization reported significantly more regret than patients undergoing AAA repair or CEA (23.6% and 20.3% vs 6.5% and 7.0%, respectively; P < .001; Fig) . No associations between decisional regret and age, sex, surgical acuity (elective vs urgent/emergent), comorbidities, or 30-day postoperative complications were identified.Conclusions: Decision regret varied significantly across vascular surgery procedure type, was significantly more common among patients undergoing LE procedures, and was not associated with perioperative outcomes. Patients undergoing LE vascular procedures might benefit from targeted education and preference elicitation to support mutual understanding and shared goals. Further research is needed to understand whether patient factors, procedural factors, and/or disease-specific factors related to the nature of peripheral artery disease are the underlying cause of decision regret.