Amputations in patients with diabetic foot ulcer

a retrospective study from a single centre in the Northern Territory of Australia

Kanakamani Jeyaraman, Thomas Berhane, Mark Hamilton, Abhilash P. Chandra, Henrik Falhammar

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Background: Lower extremity amputations (LEAs) in diabetic patients are common in the indigenous population. There is no published data from the Northern Territory.

    Methods: All patients with diabetic foot ulcer, presenting for the first time to the multi-disciplinary foot clinic at Royal Darwin Hospital, between January 2003 and June 2015, were included. These patients were followed until 2017, or death. LEA rates over the follow-up period and the risk factors were studied.

    Results: Of the 513 included patients, 62.8% were males and 48.2% were indigenous. The majority (93.6%) had type 2 diabetes with median diabetes duration of 7.0 years (interquartile range 3–12). During the follow-up period of 5.8 years (interquartile range 3.1–9.8), a total of 435 LEAs (16.6% major; 34.7% minor) occurred in 263 patients (mean age 57.0 ± 11.8 years). In multivariate analysis, the following variables were associated with LEAs (adjusted odds ratio (95% confidence interval)): prior LEA (4.49 (1.69–11.9)); peripheral vascular disease (2.67 (1.27–5.59)); forefoot ulcer (7.72 (2.61–22.7)); Wagner grade 2 (3.71 (1.87–7.36)); and Wagner grade 3 (17.02 (3.77–76.72)). Indigenous patients were 1.8 times more likely to have LEAs than non-indigenous patients. Indigenous amputees were approximately 9 years younger than their non-indigenous counterparts.

    Conclusion: Half of patients presenting with diabetic foot ulcer had LEA during follow-up. Prior LEAs, peripheral vascular disease, forefoot ulcers and higher Wagner grades were independent risk factors for LEA. Indigenous patients were at higher risk for LEAs and were younger at the time of amputation.

    Original languageEnglish
    Pages (from-to)874-879
    Number of pages7
    JournalANZ Journal of Surgery
    Volume89
    Issue number7-8
    Early online date10 Jul 2019
    DOIs
    Publication statusPublished - Jul 2019

    Fingerprint

    Northern Territory
    Diabetic Foot
    Amputation
    Retrospective Studies
    Lower Extremity
    Peripheral Vascular Diseases
    Ulcer
    Amputees
    Population Groups
    Type 2 Diabetes Mellitus
    Foot

    Cite this

    Jeyaraman, Kanakamani ; Berhane, Thomas ; Hamilton, Mark ; Chandra, Abhilash P. ; Falhammar, Henrik. / Amputations in patients with diabetic foot ulcer : a retrospective study from a single centre in the Northern Territory of Australia. In: ANZ Journal of Surgery. 2019 ; Vol. 89, No. 7-8. pp. 874-879.
    @article{1c02cb7598ac4699956ab8ed03324995,
    title = "Amputations in patients with diabetic foot ulcer: a retrospective study from a single centre in the Northern Territory of Australia",
    abstract = "Background: Lower extremity amputations (LEAs) in diabetic patients are common in the indigenous population. There is no published data from the Northern Territory. Methods: All patients with diabetic foot ulcer, presenting for the first time to the multi-disciplinary foot clinic at Royal Darwin Hospital, between January 2003 and June 2015, were included. These patients were followed until 2017, or death. LEA rates over the follow-up period and the risk factors were studied. Results: Of the 513 included patients, 62.8{\%} were males and 48.2{\%} were indigenous. The majority (93.6{\%}) had type 2 diabetes with median diabetes duration of 7.0 years (interquartile range 3–12). During the follow-up period of 5.8 years (interquartile range 3.1–9.8), a total of 435 LEAs (16.6{\%} major; 34.7{\%} minor) occurred in 263 patients (mean age 57.0 ± 11.8 years). In multivariate analysis, the following variables were associated with LEAs (adjusted odds ratio (95{\%} confidence interval)): prior LEA (4.49 (1.69–11.9)); peripheral vascular disease (2.67 (1.27–5.59)); forefoot ulcer (7.72 (2.61–22.7)); Wagner grade 2 (3.71 (1.87–7.36)); and Wagner grade 3 (17.02 (3.77–76.72)). Indigenous patients were 1.8 times more likely to have LEAs than non-indigenous patients. Indigenous amputees were approximately 9 years younger than their non-indigenous counterparts. Conclusion: Half of patients presenting with diabetic foot ulcer had LEA during follow-up. Prior LEAs, peripheral vascular disease, forefoot ulcers and higher Wagner grades were independent risk factors for LEA. Indigenous patients were at higher risk for LEAs and were younger at the time of amputation.",
    keywords = "amputation, diabetes complication, diabetes mellitus, diabetic feet, foot ulcer",
    author = "Kanakamani Jeyaraman and Thomas Berhane and Mark Hamilton and Chandra, {Abhilash P.} and Henrik Falhammar",
    year = "2019",
    month = "7",
    doi = "10.1111/ans.15351",
    language = "English",
    volume = "89",
    pages = "874--879",
    journal = "ANZ Journal of Surgery",
    issn = "1445-1433",
    publisher = "Wiley-Blackwell",
    number = "7-8",

    }

    Amputations in patients with diabetic foot ulcer : a retrospective study from a single centre in the Northern Territory of Australia. / Jeyaraman, Kanakamani; Berhane, Thomas; Hamilton, Mark; Chandra, Abhilash P.; Falhammar, Henrik.

    In: ANZ Journal of Surgery, Vol. 89, No. 7-8, 07.2019, p. 874-879.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Amputations in patients with diabetic foot ulcer

    T2 - a retrospective study from a single centre in the Northern Territory of Australia

    AU - Jeyaraman, Kanakamani

    AU - Berhane, Thomas

    AU - Hamilton, Mark

    AU - Chandra, Abhilash P.

    AU - Falhammar, Henrik

    PY - 2019/7

    Y1 - 2019/7

    N2 - Background: Lower extremity amputations (LEAs) in diabetic patients are common in the indigenous population. There is no published data from the Northern Territory. Methods: All patients with diabetic foot ulcer, presenting for the first time to the multi-disciplinary foot clinic at Royal Darwin Hospital, between January 2003 and June 2015, were included. These patients were followed until 2017, or death. LEA rates over the follow-up period and the risk factors were studied. Results: Of the 513 included patients, 62.8% were males and 48.2% were indigenous. The majority (93.6%) had type 2 diabetes with median diabetes duration of 7.0 years (interquartile range 3–12). During the follow-up period of 5.8 years (interquartile range 3.1–9.8), a total of 435 LEAs (16.6% major; 34.7% minor) occurred in 263 patients (mean age 57.0 ± 11.8 years). In multivariate analysis, the following variables were associated with LEAs (adjusted odds ratio (95% confidence interval)): prior LEA (4.49 (1.69–11.9)); peripheral vascular disease (2.67 (1.27–5.59)); forefoot ulcer (7.72 (2.61–22.7)); Wagner grade 2 (3.71 (1.87–7.36)); and Wagner grade 3 (17.02 (3.77–76.72)). Indigenous patients were 1.8 times more likely to have LEAs than non-indigenous patients. Indigenous amputees were approximately 9 years younger than their non-indigenous counterparts. Conclusion: Half of patients presenting with diabetic foot ulcer had LEA during follow-up. Prior LEAs, peripheral vascular disease, forefoot ulcers and higher Wagner grades were independent risk factors for LEA. Indigenous patients were at higher risk for LEAs and were younger at the time of amputation.

    AB - Background: Lower extremity amputations (LEAs) in diabetic patients are common in the indigenous population. There is no published data from the Northern Territory. Methods: All patients with diabetic foot ulcer, presenting for the first time to the multi-disciplinary foot clinic at Royal Darwin Hospital, between January 2003 and June 2015, were included. These patients were followed until 2017, or death. LEA rates over the follow-up period and the risk factors were studied. Results: Of the 513 included patients, 62.8% were males and 48.2% were indigenous. The majority (93.6%) had type 2 diabetes with median diabetes duration of 7.0 years (interquartile range 3–12). During the follow-up period of 5.8 years (interquartile range 3.1–9.8), a total of 435 LEAs (16.6% major; 34.7% minor) occurred in 263 patients (mean age 57.0 ± 11.8 years). In multivariate analysis, the following variables were associated with LEAs (adjusted odds ratio (95% confidence interval)): prior LEA (4.49 (1.69–11.9)); peripheral vascular disease (2.67 (1.27–5.59)); forefoot ulcer (7.72 (2.61–22.7)); Wagner grade 2 (3.71 (1.87–7.36)); and Wagner grade 3 (17.02 (3.77–76.72)). Indigenous patients were 1.8 times more likely to have LEAs than non-indigenous patients. Indigenous amputees were approximately 9 years younger than their non-indigenous counterparts. Conclusion: Half of patients presenting with diabetic foot ulcer had LEA during follow-up. Prior LEAs, peripheral vascular disease, forefoot ulcers and higher Wagner grades were independent risk factors for LEA. Indigenous patients were at higher risk for LEAs and were younger at the time of amputation.

    KW - amputation

    KW - diabetes complication

    KW - diabetes mellitus

    KW - diabetic feet

    KW - foot ulcer

    UR - http://www.scopus.com/inward/record.url?scp=85068798578&partnerID=8YFLogxK

    U2 - 10.1111/ans.15351

    DO - 10.1111/ans.15351

    M3 - Article

    VL - 89

    SP - 874

    EP - 879

    JO - ANZ Journal of Surgery

    JF - ANZ Journal of Surgery

    SN - 1445-1433

    IS - 7-8

    ER -