Risk of Reamputation in Diabetic Patients Stratified by Limb and Level of Amputation

Abstract

OBJECTIVE -This study examined the risk of reamputation, stratified by original level of amputation, in a population of diabetic patients. We also illustrated reamputation rates by ipsilateral and contralateral limbs.RESEARCH DESIGN AND METHODS -The study population included 277 diabetic patients with a first lower-extremity amputation performed between 1993 and 1997 at University Hospital in San Antonio, Texas. Reamputation episodes for the ipsilateral and contralateral limbs were recorded through 2003. Using a cumulative incidence curve analysis, we compared the reamputation rate by limb. Cumulative rates of reamputation were calculated for each limb at each amputation level at 1, 3, and 5 years.RESULTS -Cumulative rates of reamputation per person were 26.7% at 1 year, 48.3% at 3 years, and 60.7% at 5 years. Ipsilateral reamputation per amputation level at the 1-, 3-, and 5-year points were toe: 22.8, 39.6, and 52.3%; ray: 28.7, 41.2, and 50%; midfoot: 18.8, 33.3, and 42.9%; and major: 4.7, 11.8, and 13.3%. For contralateral reamputation, the rates at 1, 3, and 5 years were toe: 3.5, 18.8, and 29.5%; ray: 9.3, 21.6, and 29.2%; midfoot: 9.4, 18.5, and 33.3%; and major: 11.6, 44.1, and 53.3%.CONCLUSIONS -This study showed that a patient is at greatest risk for further same-limb amputation in the 6 months after the initial amputation. Although risk to the contralateral limb rises steadily, it never meets the level of that of the ipsilateral limb. This finding will help clinicians focus preventive efforts and medical resources during individualized at-risk periods for diabetic patients undergoing first-time amputations. Diabetes Care 29:566 -570, 2006F oot ulcers and lower-extremity amputations (LEAs) are disabling complications of diabetes that can lead to significant increases in mortality and morbidity (1,2), most notably recurrent amputation at increasingly higher levels. It has been shown that a history of ulceration increases the risk of amputation (3,4), as do prior amputations (4). Several studies have reported reamputation rates (5-15). However, the results of these studies are too general to apply to individual patients; some studies combined reamputation episodes of both ipsilateral and contralateral limbs (5-7) and others addressed reamputation of only one extremity (8 -10). Reamputations at specific levels have been studied (11-15), but how the rates differ by level of amputation is still unknown. In addition, many of these studies included reamputations for patients with existing amputations. The true reamputation rate of first-time amputations has not been reported before this study.In this retrospective cohort study, we aimed to 1) illustrate the difference between the reamputation risk for ipsilateral and contralateral limbs and 2) stratify the risk of reamputation by the original level of amputation. With these findings, we hope to help clinicians estimate individualized risk for patients based on the level of first-time amputation.RESEARCH DESIGN AND METHODS -In this retrospective cohort study,...

Diabetic foot ulceration and amputation

“…Age and heel lesions have also been shown to be risk factors for re-amputation (Skoutas et al, 2009). Risk of re-amputation is highest within the first 6 months of initial amputation (Izumi et al, 2006;Skoutas et al, 2009). A re-amputation rate of 21.5% within 18 months was reported by Skoutas et al (2009) and 1 year and 3 year rates of 26.7% and 48.3% by Izumi (2006).…”

“…Risk of re-amputation is highest within the first 6 months of initial amputation (Izumi et al, 2006;Skoutas et al, 2009). A re-amputation rate of 21.5% within 18 months was reported by Skoutas et al (2009) and 1 year and 3 year rates of 26.7% and 48.3% by Izumi (2006). Forty percent of subjects with DM in a study by Tentolouris et al had an ipsilateral or contralateral amputation within an average of about 16 months of the first DM-related LEA (Tentolouris et al, 2004).…”

The correlation of fasting blood glucose levels with the severity of diabetic foot ulcers and the outcome of treatment strategies

“…Statistics have shown that, out of the 80,000 amputations performed in the USA per annum, approximately half of these belong to below-knee or more proximal amputations [35]. The estimated 1-year mortality rate after a below-knee amputation ranges between 20.8% and 35.5% [36], with a reported contralateral limb loss rate of 53.3% within 5 years [37]. Research has deduced that proximal amputations result in decreased ambulatory status due to inefficient biomechanics, hence when possible, partial foot amputation is recommended that will reduce morbidity and will help restore biomechanics esp.…”

Amputee Mobility Predictor-Bilateral: A performance-based measure of mobility for people with bilateral lower-limb loss

“…Although the actual incidence of bilateral amputation has not been reported, it has been established that 30 to 50 percent of people who have an amputation related to diabetes will undergo amputation of the contralateral limb 3 to 5 yr after the primary amputation [2][3]. Moreover, with the increase in world conflict over the past decade with Operation Iraqi Freedom/Operation Enduring Freedom, coupled with medical advancements and improved emergency medical technician services domestically and abroad, the number of individuals surviving with traumatic bilateral lower-limb amputation (BLLA) has increased [4][5].…”