Reamputation after Minor Foot Amputation in Diabetic Patients: Risk Factors Leading to Limb Loss

Nerone, Vincent S.; Springer, Kevin D.; Woodruff, Darren M.; Atway, Said

doi:10.1053/j.jfas.2012.11.015

Cited by 37 publications

(32 citation statements)

References 34 publications

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“…The results also demonstrated that there was no significant difference for the risk of minor amputation and major amputation in the amputation group. The results were similar to a study conducted by Nerone et al (27), in which smoking made no difference to the amputation outcome (minor or major amputation). The combined results of the primary analysis of the present study indicated no significant publication bias.…”

Section: Discussionsupporting

confidence: 90%

“…Following the reading of the full text of the remaining 47 articles, 39 articles were excluded, including six reviews, 22 articles in which the data could not be extracted and 11 articles with duplicated populations. Finally, eight documents were included in this meta-analysis (23)(24)(25)(26)(27)(28)(29)(30).…”

Section: Resultsmentioning

confidence: 99%

“…Table I indicates the basic information of the studies involved in the meta-analysis. The enrolled eight studies included five cohort studies (22)(23)(24)26,27) and three case control studies (20,21,25). The publication year ranged from 1992-2015.…”

Section: Resultsmentioning

confidence: 99%

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Smoking increases the risk of diabetic foot amputation: A meta-analysis

et al. 2017

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Abstract. Accumulating evidence suggests that smoking is associated with diabetic foot amputation. However, the currently available results are inconsistent and controversial. Therefore, the present study performed a meta-analysis to systematically review the association between smoking and diabetic foot amputation and to investigate the risk factors of diabetic foot amputation. Public databases, including PubMed and Embase, were searched prior to 29th February 2016. The heterogeneity was assessed using the Cochran's Q statistic and the I 2 statistic, and odds ratio (OR) and 95% confidence interval (CI) were calculated and pooled appropriately. Sensitivity analysis was performed to evaluate the stability of the results. In addition, Egger's test was applied to assess any potential publication bias. Based on the research, a total of eight studies, including five cohort studies and three case control studies were included. The data indicated that smoking significantly increased the risk of diabetic foot amputation (OR=1.65; 95% CI, 1.09-2.50; P<0.0001) compared with non-smoking. Sensitivity analysis demonstrated that the pooled analysis did not vary substantially following the exclusion of any one study. Additionally, there was no evidence of publication bias (Egger's test, t=0.1378; P=0.8958). Furthermore, no significant difference was observed between the minor and major amputation groups in patients who smoked (OR=0.79; 95% CI, 0.24-2.58). The results of the present meta-analysis suggested that smoking is a notable risk factor for diabetic foot amputation. Smoking cessation appears to reduce the risk of diabetic foot amputation.

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Section: Discussionsupporting

confidence: 90%

Section: Resultsmentioning

confidence: 99%

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Smoking increases the risk of diabetic foot amputation: A meta-analysis

et al. 2017

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“…[14,15] In addition, approximately 30% to 40% of the patients with a diabetic foot have undergone at least 1 reamputation after a previous debridement or minor amputation. [9] Therefore, it can be a challenge to ensure sufficient anesthetic and analgesic effects while maintaining stable hemodynamics in these patients.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the effects of remifentanil-based general anesthesia and popliteal nerve block on postoperative pain and hemodynamic stability in diabetic patients undergoing distal foot amputation

et al. 2016

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Diabetic foot ulcer is the most common cause of diabetes-associated nontraumatic lower extremity amputation. Most patients who undergo lower extremity amputation for a diabetic foot have had diabetes for a long time and suffer from multiorgan disorder; thus, it can be a challenge to ensure sufficient anesthetic and analgesic effects while maintaining stable hemodynamics. Recently, peripheral nerve block has gained popularity owing to its attenuating effects of systemic concerns. This retrospective observational study aimed to compare the effects of remifentanil-based general anesthesia (GEA) and popliteal nerve block (PNB) on postoperative pain and hemodynamic stability in diabetic patients undergoing distal foot amputation.A total of 59 consecutive patients with a diabetic foot who underwent distal foot amputation between January 2012 and May 2014 were retrospectively reviewed. Patients received remifentanil-based GEA (GEA group, n = 32) or PNB (PNB group, n = 27). The primary outcomes were to evaluate postoperative analgesic effects and perioperative hemodynamics. Also, postoperative pulmonary complications and 6-month mortality were assessed as secondary outcomes.Significant differences in pain scores using numeric rating scale were observed between the groups in a linear mixed model analysis (PGroup×Time = 0.044). Even after post hoc analysis with the Bonferroni correction, the numeric rating scale scores were significantly lower in the PNB group. Furthermore, patients in the PNB group required less pethidine during the first 6 hours after surgery (27 ± 28 vs 9 ± 18 mg; P = 0.013). The GEA group had a lower mean blood pressure (Bonferroni-corrected P < 0.01), despite receiving more ephedrine (P < 0.001). Significantly more patients in the GEA group suffered from postoperative pneumonia and required the management in intensive care unit (P = 0.030 and 0.038, respectively). However, the groups did not differ in terms of 6-month mortality.This study demonstrated that compared with remifentanil-based GEA, PNB might be a favorable option for diabetic patients undergoing distal foot amputation, despite the lack of significant mortality benefits, as PNB was associated with improved postoperative analgesia, hemodynamic stability, and a low incidence of pulmonary complications during the immediate postoperative period, especially in high-risk patients.

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“…The heavy economic burden on health systems in the order of £12 billion per annum [2] is accompanied by a major impact on the patients' quality of life [2]. Furthermore, the rate of amputation ranges currently from 5.5% (major amputations) to 22.6% (minor amputations) in the diabetic population [12], with the presence of PAD being identified as a key risk factor for amputation in this patient group [13]. Given that the prevalence of PAD in patients with diabetes may reach up to 20.6% [3] it is important to identify those patients who are at greater risk of a negative clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

Effect of diabetes on the cutaneous microcirculation of the feet in patients with intermittent claudication

Klonizakis

Manning

Lingam³

et al. 2016

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Aims: To evaluate endothelial-dependent and -independent cutaneous vasodilator responses in the feet of patients with peripheral arterial disease (PAD) with or without Type 2 diabetes.Methods: Cutaneous microvascular responses in the dorsum of both lower limbs were measured in the supine position using Laser Doppler Fluximetry combined with iontophoretic administration of endothelial-dependent (acetylcholine, Ach) and -independent (sodium nitroprusside, SNP) vasodilators in diabetic (n=19) and non diabetic (n=17) patients with PAD (presenting as unilateral calf intermittent claudication (IC).

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Reamputation after Minor Foot Amputation in Diabetic Patients: Risk Factors Leading to Limb Loss

Cited by 37 publications

References 34 publications

Smoking increases the risk of diabetic foot amputation: A meta-analysis

Smoking increases the risk of diabetic foot amputation: A meta-analysis

Comparison of the effects of remifentanil-based general anesthesia and popliteal nerve block on postoperative pain and hemodynamic stability in diabetic patients undergoing distal foot amputation

Effect of diabetes on the cutaneous microcirculation of the feet in patients with intermittent claudication

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