The effect of comorbid factors and amputation level on mortality in geriatric patients with diabetic foot

Abstract

Diabetes mellitus (DM) is a serious global health issue and one of the most prevalent morbidities, impacting 366 million individuals worldwide in 2011. [1] This number is expected to rise to 552 million by 2030. [1] Most of the patients with chronic illnesses did not have a regular follow-up during the pandemic due to individuals' fear of getting the virus or self-isolation regulations. [2] Patients with DM have a lifetime risk of up to 25% of developing diabetic foot; however, approximately 60 to 80% of patients' foot ulcers heal, while 10 to 15% do not progress and 5 to 24% eventually require a limb amputation. [3] Lower limb amputation (LLA) patients have a significant mortality rate, which may be due to the fact that the majority of patients are elderly and have many comorbid conditions in addition Objectives: The aim of this study was to evaluate the factors that influenced one-year and five-year mortality and to compare major and minor amputations in diabetic patients with comorbidities.Patients and methods: Between February 2008 and November 2014, a total of 201 type 2 diabetic foot patients (147 males, 54 females; median age: 65.99 years; range, 50 to 92 years) who underwent amputation were retrospectively analyzed. The patients were divided into two groups according to their initial amputation level: Group 1 (n=100), minor amputation group, which included the distal region of the ankle joint and Group 2 (n=101), major amputation group, which included trans-tibial amputation, trans-femoral amputation and hip disarticulation. Clinical data including patients' demographic features, re-amputation degree, length of hospitalization, hyperbaric oxygen therapy, comorbidities, blood parameters, and survival rates were recorded. Results:The regression analysis of one-year mortality found that the presence of cerebrovascular disease increased death by 2.463 times (p=0.002). Minor amputation increased mortality by 2.284 (p=0.006), and each unit increase in patient age increased mortality by 1.05 (p=0.008). Chronic renal failure increased death by 3.164 times (p<0.001) in the five-year mortality regression analysis. Conclusion:Minor amputations have an effect on one-year mortality, as do cerebrovascular disease and age. On the other hand, chronic renal failure has a negative impact on five-year mortality. Minor amputations may have a detrimental effect on mortality due to the ongoing progression of diabetic foot disease and the involvement of comorbidities. Comorbidities associated with amputations of the diabetic foot have a significant impact on mortality.